INHALATION 



ITS THERAPEUTICS AND PRACTICE. 



A TEBATISE 



INHALATION OF GASES, VAPOKS, NEBULIZED 
FLUIDS, AND POWDEKS, 

INCLUDING 

A DESCRIPTION OF THE APPARATUS EMPLOYED, AND A RECORD 

OF NUMEROUS EXPERIMENTS, PHYSIOLOGICAL AND 

PATHOLOGICAL ; WITH CASES. 

V 

By J. SOLIS COHEN, M.D. 



c ^ofCo^ 



lllnstrata 1SS7 



*' of Washing 



PHILADELPHIA: 
LINDSAY & BLAKISTON. 

1867. 



^ 



N <^ 






Entered according to Act of Congress, in the year 1867, 

By LINDSAY & BLAKISTON, 

In the Clerk's Office of the District Court of the United States for 
Eastern District of Pennsylvania. 



PHILADELPHIA: 
CAXTON PRESS OP SHERMAN & CO. 



CONTENTS. 



PAGE 

Preface, v 

Introduction, vii 

Part L 
Inhalation of Nebulized Fluids. 

CHAPTER I. 

Nebulized Medicaments and the Apparatus for their Pro- 
duction, 13 

CHAPTER II. 

Experiments upon Men and Animals, with Pathological 
Proof of the Entrance of Nebulized Eluids into the Respi- 
ratory Passages, 39 

CHAPTER III, 

Manner of Conducting Inhalation of Nebulized Fluids ; their 
Immediate Effects; their Number, Strength, and Dura- 
tion, &c, .,,<«,.... 75 

CHAPTER IT, 

Articles of the Materia Medica suitable for Nebulization, . 88 

CHAPTER V. 

Diseases to the Treatment of which this Method is Appli- 
cable, 99 



IV CONTENTS. 

Part II. 

PAGR 

Inhalation of Medicated Airs, Gases, and Yapors, . 175 

Part III. 
Inhalation of Powders. 

CHAPTER I. 

Inhalation or Insufflation of Powders in Affections of the 
Respiratory Organs, . 270 

CHAPTER II. 

Experiments Proving their Penetration into the Respiratory 
Tract, 277 

CHAPTER III. 

Pathological Proofs of the Penetration of Powders into the 
Pulmonary Tissue, ........ 282 

Index, > 295 



* 



ERRATA. 

Page 32, 6th line from top, for 1865 read 1866. 
" 175, 7th " bottom, for employed read described. 
" 225, 3d " " " adapted read adopted. 



PREFACE. 



Inhalation, especially by the method of nebuliza- 
tion, is at present attracting favorable attention from 
the profession. 

At the annual meeting of the American Medical As- 
sociation, held in Baltimore, in 1866, a committee, of 
which the writer was chairman, was appointed to pre- 
pare for the meeting of 1867 a report on the Therapeu- 
tics of Inhalation. In the preparation of this report, 
the writer accumulated a quantity of material much too 
voluminous for that purpose, and determined to incor- 
porate the most valuable portions in book-form, present- 
ing in some detail the historical record of experiments, 
pathological studies, &c, from which conclusions were 
drawn for the report. The principal literature on the 
subject is foreign — for the most part German — the most 
elaborate work being (Die Inhalations- Therapie) by 
Dr. George Lewin, of Berlin, from which much has been 
drawn in the preparation of the present volume, besides 



VI PREFACE. 

which, as will be seen, many other authors have been 
consulted, as also an extensive file of foreign and Ameri- 
can journals ; while the private experience of several 
practitioners in this country has been laid under contri- 
bution. 

Philadelphia, No. 127 South Tenth Street, 
October 1, 1867. 



INTRODUCTION. 



In examining the literature upon our subject, we find 
that inhalation has been employed from the earliest ages 
in Greece, in Rome, in Arabia, and thence, with the 
extension of medical knowledge, everywhere. Again 
and again has the method been extensively resorted to, 
and subsequently fallen into disuse, perhaps into abuse, 
for at each resumption it has seemed necessary to ad- 
vance specious reasons accounting for its previous neg- 
lect. 

Of late, new discoveries in pneumatics have at various 
periods given an impulse to further investigation of the 
subject, and at each time with some permanent benefi- 
cial result. 

Thus the discovery of oxygen by Priestly and Scheele 
in the middle of the last century, led to experiments 
upon the economy with "different kinds of air," and 
atmospheres noxious and innocuous were pressed into 
the service of therapeutics. 

Then, early in the present century, the discovery of 
the peculiar properties of chlorine and iodine, led anew 
to examination of the physical properties of volatile 
substances ; and the inhalations of resinous materials, 
of narcotics, &c, were again brought into medical 
requisition. 

Again, the observed effects of compressed air in cer- 
tain of the mechanical employments, attracted experi- 
ment as to its value as a therapeutic agent. 

Finally, the recent discovery of a method of subdivid- 
ing liquids into a cloud or nebula, and thus utilizing 



Vlll INTRODUCTION. 

them to the purposes of inhalation, and enlarging at 
once its sphere of usefulness, has given a fresh impetus 
to the study of the Therapeutics of Inhalation, which 
bids fair to result in the acquisition of new and valua- 
ble methods for at least affording grateful relief in those 
pulmonary affections, to the cure of which, medicine is, 
unfortunately, inadequate. 

The personal attention necessary to insure proper in- 
halation, even of the most volatile substances, has no 
doubt debarred many physicians from a resort to the 
method, in preference to the much easier plan of advis- 
ing a patient to swallow a draught or a pill ; and this, 
perhaps, is the reason why it has heretofore been found 
principally in use by a class of practitioners, " who," to 
use the language of the author of one of our best works 
on Therapeutics, "inhabit the debatable region between 
medicine and quackery." Dr. Rogers, in a note to 
Elliotson's Practice, Philadelphia Edition, 1844, p. 804, 
says : " A medical man, when he orders a patient to in- 
hale vapors, must give his personal attention to the 
manner in which it is performed if he wishes to have his 
intentions efficiently carried out. On one occasion, in 
a large hospital, when a patient with ulcerated sore 
throat had been ordered to inhale steam, I found him 
with a tin inhaler comfortably tucked under the bed- 
clothes with a cork stuffed into the air-tube. The con- 
sequence of this was that the patient was obliged to re- 
move his mouth from the instrument after every inspi- 
ration, and after all his laborious efforts the supply of 
steam was very inefficient. The nurse (in every respect 
an excellent one), on being questioned as to the use of 
the cork, very naturally replied that it was Ho keep in 
the steam ;' and added, that she had been in the hos- 



INTRODUCTION. IX 

pital eleven years and never saw an inhaler used in any 
other way. There is nothing surprising in all this. 
Nurses are not expected to understand the principles of 
pneumatics. On instituting an inspection of the other 
inhalers in the hospital, every one of them was found 
duly provided with a cork." 

The material collected in the following pages will 
show that inhalation has at all times possessed the con- 
fidence of men in good professional repute. Our va- 
rious works on Therapeutics and Materia Medica, Cop- 
land's Dictionary, and the works on Practice issued 
in the earlier portion of the present century, give his- 
torical lists, more or less complete, of the various au- 
thorities who have at times employed inhalations and 
recommended them, as well as lists of the remedies re- 
sorted to. To have presented a complete list in the pres- 
ent volume would have occupied many pages that are 
devoted to matter more practical, and the writer has 
been unwilling to furnish an incomplete record. In- 
stead of an extended display of authorities, therefore, 
reference is made in each appropriate place to those in- 
dividuals to whom the profession is indebted for having 
first prominently placed before them the merits of the 
inhalations of various remedies in certain diseases ; and 
with regard to the new method of inhaling nebulized 
fluids, the authorities cited are, as far as possible, au- 
thenticated, and credit given to the sources from which 
information has been derived. 

The subject is necessarily incomplete ; the observa- 
tions made in various directions are not yet sufficiently 
numerous or corroborative of each other for the deduc- 
tion of positive conclusions ; and it is to be regretted 
that the value of a faithful record of unfavorable results 



X INTRODUCTION. 

has not attracted a sufficient share of attention from 
those who have hitherto written on the subject. 

Such observations and records of authors, abroad and 
at home, as have seemed to the writer most valuable from 
the mass of matter which has accumulated on his hands, 
are laid before the reader that he may form his own 
estimate of their value. The writer has endeavored to 
present the subject as impartially as a decided bias in 
favor of inhalations would permit. 

It may not be amiss here to answer an objection that 
will often be heard urged against inhalation. It is 
this : Inhalation being defended on the ground that af- 
fected structures are thus subjected to local treatment ; 
and, at the same time, it being impossible to limit the 
local action to the diseased structures ; where, then, the 
great benefit ? We see, however, that the objection holds 
good in a measure, with regard to medicines given by 
the stomach ; they affect more or less the entire system, 
though their action may predominate in some one direc- 
tior. ' r but there is a class of therapeutists who teach that 
it is by sustaining those portions of organs still healthy, 
and protecting them against the extension of morbific 
processes, which have already imperilled the integrity 
of part of their substance, or at any rate temporarily 
impaired their natural functions, that we are able to ex- 
tend the restorative influence by continuance of molecu- 
lar action into the very structures diseased, and thus 
excite them, as far as they are not disorganized or 
changed, to a return of normal function. Healthy tis- 
sues, too, resist the effect of medicines, local or general ; 
thus we can rarely restrict the action of a lotion or a 
caustic to the diseased structures, the parts immediately 
adjacent often receive a full benefit from the applica- 



INTRODUCTION. XI 

tion ; still, that affords no valid argument against the 
use of such local treatment. 

It seems plausible, too, that even when remedies act 
systemically, we should anticipate better results by 
impressing first the particular organs designed to be 
acted upon with any remedy by its passage through the 
system, than by impressing the system primarily and 
the affected organ secondarily, by the passage through it 
of medicated blood-plasma, or modified nerve-force ; be- 
sides which, the systemic exhalants are more actively 
called upon for their emunctorial duties, than are the 
systemic absorbents for the impression of some special 
organ ; added to which, the changes which may occur 
during the progress of the digestion of a medicine may 
alter its primary effect; and if any difference has been 
detected in the effect of any remedy as administered by 
inhalation or deglutition, it is not illogical to trace the 
cause, in a great measure, to the digestive process to 
which it is subjected in the stomach, where the remedies, 
undergo preparation for absorption. We administer 
remedies for the production of effects known to occur 
after exposure to the digestive process, and it may be 
possible that their action would be different were they 
not thus digested ; at any rate, we act upon such 
premises, for we diminish the quantity of medicine to 
be introduced by direct absorption into the body for a 
certain effect, whether by the skin or by the bronchial 
mucous membrane; and therefore, in resorting to inha- 
latory therapeutics, we must carefully watch the effect 
of remedies, for it may require much judgment in the 
selection of a special materia inedica. One advantage 
is, that remedies exhibited for inhalation are usually 
presented in a simply medicinal form, deprived in great 



XU INTRODUCTION. 

measure of the original (resinous, woody, or other) con- 
necting medium, which is more apt to be preserved as 
usually administered, while the misfortunes and errors 
of the elaborate prescriptions of polypharmacists are 
less apt to be endured by the patient. 

The mucous membrane of the respiratory organs has 
a much greater capacity for absorption than that of the 
stomach, than which it is much more delicate ; and for 
articles not desirable to be exposed to the solvent prin- 
ciple of the gastric juice, inhalation is at least as ad- 
vantageous a mode, in many instances, for the adminis- 
tration of appropriate remedies, as the skin or connective 
cellular tissue. The material inhaled comes directly in 
close juxtaposition to the blood while in its most vital 
state, and is thus more promptly and more thoroughly 
absorbed into the tide of the circulation than when it 
performs part of the venous circuit before exposure to 
the inspiratory effort. It is often, too, advantageous 
that nothing shall interfere directly with the digestive 
functions. 

The promptness with which the respiratory mucous 
membrane absorbs is well shown in the action of general 
anaesthetics, and he who is skeptical as regards the 
facility with which other articles of the materia medica 
are absorbed, can perform upon himself the experiment 
of taking a certain amount of a narcotic by the stomach, 
and at another time, under similar conditions of body as 
well as may be, inhaling a similar amount of the same 
narcotic in solution, by some of the methods described 
in the pages of this volume ; and, unless he be the sub- 
ject of some idiosyncrasy, the truth of the matter may 
safely rest upon his own verdict as to the resulting 
sensations. 



ON INHALATION. 



PART I. 

INHALATION OF NEBULIZED FLUIDS. 

CHAPTER I. 

NEBULIZED MEDICAMENTS AND THE APPARATUS FOR 
THEIR PRODUCTION. 

Every one who has seen a waterfall strike upon the 
rocks below it, knows how portions of the stream are 
broken by the concussion into a coarser or finer spray 
which remains for a time suspended in the atmosphere. 
A stream of water forced through a narrow tube against 
a firm resistance will produce the same effect, as we 
sometimes see in the more remote particles of the water 
as it is dashed from a building against which an engine 
is playing. These remote particles are no longer in 
contact, but are separate molecules, which, as soon as 
they alight, are condensed into drops. 

On this principle, it occurred to Auphan, at Euzet- 
les-Bains, in 1849, to break up the mineral water of 
that watering-place into a fine spray, for purposes of 
inhalation, by forcing a delicate stream to impinge 
against the walls of the apartment. The same system 
was adopted shortly after at Jjamotte-les- Bains ; and 
subsequently Sales-Girons, in conjunction with M. de 

2 



14 NEBULIZED MEDICAMENTS 

Flube, proprietor of the baths at Pierrefonds, a water- 
ing-place near Compeigne, and who first suggested the 
idea of pulverizing liquids without employing a blast 
of air, constructed an apparatus for converting these 
mineral waters into the finest possible spray, with 
the idea of more thoroughly preparing them for the 
treatment of diseases of the respiratory organs. Sales- 
Gtirons read a paper entitled, u Memoir e sur la Chambre 
de Respiration nouvelle de Pierrefonds" before the Hy- 
drological Academy of Paris, on December 8th, 1856 ; 
in which he described his inhalatorium, and contended 
that the spray penetrated deeply into the respiratory 
tract. Doubts were expressed by many of the members 
as to the fact of such penetrations, and shortly after, 
experiments were instituted at the different spas to solve 
the mooted question. 

Sales-Girons' inhalatorium was a chamber seven me- 
tres long, four and a half metres wide, and three metres 
high, in which it was intended that several patients, 
from one to fifteen, should take inhalations together. 
During the inhalations the window of the apartment 
was kept open, and the condensed fluid which accumu- 
lated upon the floor was carried off by a waste pipe. 
The patients were prevented from being wet through 
by appropriate coverings. A suction pump outside of 
the chamber drew the mineral water up into a tube, 
which passed through a water-bath heated to the de- 
sired temperature, and then passed into the chamber, 
where it terminated in a vertical cylinder to the end of 
which was attached the pulverizer or apparatus for pro- 
ducing the spray. Six fine grooves in the cylinder, 
controlled by a stop-cock, gave exit to as many strongly 
compressed streams of mineral water, which, striking 
with great force against a metallic plate at short range, 






AND THE APPARATUS FOR THEIR PRODUCTION. 15 

were thence distributed in the atmosphere jn the form 
of a fine spray. (Therapeutique Respiratoire ; Traite 
Theorique et Pratique des Salles de Respiration Nou- 
velles a Veau Minerale Pulverisee, pour le traitement des 
Maladies de Poitrine. Par le Docteur Sales-Girons, 
Medicin-Inspecteur des Eaux Sulfureuses de Pierre- 
fonds, 1858.) 

MM. Patissier and Ossian Henry visited the inhala- 
torium at Pierrefonds, and reported to the Academy of 
Paris that they were satisfied that the sprays produced 
at that establishment contained all the elements of the 
original mineral water. Sales-Girons received a silver 
medal from the Academy as a recognition of his val- 
uable addition to our therapeutic resources. 

Subsequently, Sales-Girons devised a portable ap- 
paratus, a pulverisateur poi'tatif des liquides medica- 
rnenteux, which can be used in any apartment, and 
through which any medicated liquid can be broken up 
into spray as fine as that produced in his inhalatorium. 
A committee consisting of MM. Gavarret, Patissier, 0. 
Henry, and Poiseuille, presented a favorable report on 
this apparatus to the Parisian Academy of Medicine. 

The convenience of such an instrument at once com- 
mended itself to those desirous of employing the new 
method of medication, and gave an excellent opportu- 
nity to its adherents and opponents for experiment at 
their convenience as to the penetration of the spray 
into the respiratory tract. This apparatus (Fig. 1) was 
manufactured by Charriere, of Paris, and is known as 
the first model of Charriere. It consists of a metallic 
vessel of the capacity of from eighteen to twenty 
ounces, which is to be filled two-thirds with the liquid 
intended to be pulverized. In the neck of this vessel 



16 



NEBULIZED MEDICAMENTS 



there screws a compression pump (condensing syringe), 
which, by compressing the air above the liquid, drives 
the latter through a capillary tube against a convex 
button, in close proximity, with such force that it is 
from that point deflected off in a fine spray. A man- 
ometer attached to the instrument shows the amount of 

Fig. 1 .* 




Sales-Girons' Pulverisateur Portatif. (From Lewin.) 

* a, compression pump ; b, reservoir ; c, stream of fluid about 
to strike the button which is concealed within the drum ; d, tube 
with stop-cock ; /, drum or cylinder in which the excess of spray 
is condensed ; g, waste tube to carry off the condensed fluid ; h, 
manometer. 



AND THE APPARATUS FOR THEIR PRODUCTION. 17 

pressure employed, the usual pressure being a force of 
from three to five atmospheres. 

The second model of Charriere differs from the first 
in the reservoir being made of glass, and the glass tube 
through which the stream of fluid is forced, dipping 
down into the fluid. 

In the third model of Charriere, water pressure is 
used instead of compressed air ; but the pressure soon 
giving out, it requires to be kept in motion more fre- 
quently. 

Later, M. Matthieu (de la Drome) constructed a 
portable spray producer according to a principle sug- 
gested by H. Tirman, and which consists in the forcible 
extrusion of air and fluid at the same time. The prin- 
ciple will be recognized by taking an ordinary syringe 
after it has just been discharged of its contents, drawing 
back the piston, and then projecting it forward with 
force. The fluid remaining in the nozzle will be for- 
cibly ejected with the escaping air, and will be con- 
verted into spray ; and it may be mentioned in passing 
that a syringe thus handled, or the little gum-ball 
douches, now used for nasal, aural, and urethral injec- 
tions, — taking up but a drop or so of liquid and then 
propelling it out with great force, affords an excellent 
method of medicating locally the fauces, tonsils, pha- 
rynx, &c. The smaller the opening of the nozzle of 
the syringe, the finer will be the spray. 

Matthieu' s apparatus was exhibited to the Parisian 
Academy of Medicine on the 9th of May, 1859 {Gazette 
des Hdpitaux, 1859, p. 297), and is called by him a 
Ne'phogene, or, as we have anglicized it, a nebulizer, 
which is a more correct name for these instruments 
than pulverizer or atomizer, for the liquid is not pul- 

2* 



18 



NEBULIZED MEDICAMENTS 



verized nor atomized, but simply broken up into a cloud 
or nebula. This instrument (Fig. 2) consists of a 
Heron's ball, in which the air is compressed. After the 



Fig 




Matthieu's Nephogene. (From Lewin.) 

necessary pressure has been produced, on opening the 
vent, which is controlled by a stop-cock, this com- 
pressed air rushes out with great force, and, in escap- 
ing, drives before it and with it a small quantity of the 
desired fluid, which is allowed to drip into the exit 
tube from a glass globe above ; and as it leaves the cap- 
illary opening at the extremity, it emerges to all sides 
in a fine spray ; a lamp warms the spray as it escapes. 
There are several objections to the employment of 
this apparatus for inhalatory purposes. A large quan- 
tity of compressed air is forced out, and the liquid is 
driven into the mouth in a straight line, and with such 



* a, compression pump ; b, glass globe containing the fluid to 
be nebulized; c, exit tube; d, flexible tube conveying the con- 
densed air from the reservoir to the exit tube ; /, air reservoir. 



AND THE APPARATUS FOR THEIR PRODUCTION. 19 

force that the ordinary strength of an inspiratory effort 
cannot deflect it into the air-passages, and the greater 
part of it condenses upon the pharynx and soft palate, 
and sometimes strikes these parts with such force (ac- 
cording to Lewin) as to cause spasmodic closure of the 
glottis and excite spasms of coughing. It is but fair to 
mention that this instrument was originally intended 
for administering a spray bath to any individual por- 
tion of the body. {See Gaz. Hebdom., May 4, 1860, and 
\_Matthieus tetter] May 11, 1860.) 

Lambron, Velpeau, and others have constructed sim- 
ilar instruments on the same principle. {Lewin.) 

Sales-Girons also constructed a third instrument, in 
which the spray is produced by the agency of bristles 
attached to the circumference of a wheel. As the wheel 
is rapidly turned, the brushes dip into the fluid to be 
nebulized, and as they emerge from it strike with force 
against a ledge, and thence the fluid is disseminated as 
a fine spray. {Fieber.) 

Lewin, of Berlin, has constructed an apparatus with 
an ordinary suction pump (syringe) which forces the 
liquid into a reservoir, the air within which is thus com- 
pressed, and in its turn becomes a propelling force 
driving the fluid, by the opening of a valve, out of a 
very fine aperture, whence it impinges on a convex 
button, and is thus broken into spray. This apparatus 
once set in action will continue to work for a consider- 
able time without further pumping. 

Waldenburg {Die Inhalationen der zerstdubten 
Fliissigkeiten, &c, von Dr. L. Waldenburg, Berlin, 
1864), has constructed an apparatus with a suction and 
forcing pump (the same sort of pump that is furnished 
with Mayer's uterus douche), which draws the liquid 



20 NEBULIZED MEDICAMENTS 

from a second vessel, and then drives it out, through a 
capillary opening, against a cylindrical drum with a 
concave plate of metal (a la Sales-Girons). A tube at- 
tached to the drum conveys the condensed excess of 
spray back to the reservoir, so that the same liquid can 
be used again and again for some time. Waldenburg 
also conceived the idea of suspending the nebulized 
spray in connection with the vapor of water ; and he 
adjusted a flask in which the water or desired decoction 
was made to boil, so that the steam passed through the 
cylindrical drum of his nebulizer and thus mingled with 
the spray. 

Subsequently he constructed, after a plan suggested 
to him by Reichenheim, a chemist, an apparatus in 
which the steam and the nebulized fluid was produced 
at the same time. A convenient vessel was tightly 
closed by a cork. Through an opening in the cork 
dipped a wide tube nearly to the bottom of the vessel. 
The tube gradually narrowing terminated at its bent 
extremity outside of the vessel in a capillary opening. 
The vessel, filled nearly full of a watery fluid, being 
heated, a portion of the fluid is converted into vapor, 
and, as it cannot escape through the cork, it presses 
more and more by its continued evolution upon the 
upper surface of the fluid, and in its escape drives out 
some of the fluid before it through the exposed extrem- 
ity of the tube dipping into the vessel. Then by direct- 
ing the escaping stream against some appropriate resist- 
ance, as a convex metallic lens, the simultaneous pro- 
duction of steam and spray may be kept up for a con- 
siderable time. 

Dr. J. Schnitzler ( Wiener Medicinhalle, 1862, No. 
29, Fieber, Lewin et al.) has constructed an apparatus. 



AND THE APPARATUS FOR THEIR PRODUCTION. 21 

This consists of a stout cylinder of glass, with an air- 
tight metallic cap and base: the air in the vessel which 
contains the fluid is compressed by a screw instead of a 
vertical piston, and when the cock is opened, after a 
few rapid turns of the screw have produced the desired 
pressure, the stream rushes out through a capillary 
tube, and impinges against a lens in close proximity. 
With this apparatus the lens against which the fluid is 
nebulized can be held in the mouth of the patient so as 
to prevent too great a loss of fluid. 

Fournie {Gazette des Hopitaux, July, 1861) has 
constructed an apparatus composed of a compression 
pump, and a reservoir with a stop-cock ; a glass cylin- 
der with a tube ending in a capillary opening and made 
of platinum ; beneath the capillary extremity of the 
tube a lens on which the impinging stream is nebulized. 
In this apparatus also, the lens can be inserted within 
the mouth and the nebulization take place there. 

The most convenient apparatus working by pressure, 
next to that of Lewin, to be described presently, and 
for promoting deep inhalations of any fluid which will 
not be acted upon by metal, is the modification of 
Sales- Girons, figured on the next page, and manu- 
factured by L. Mathieu (cutler), of Paris. It is 
readily managed, and produces a more minute spray 
than any other instrument I have seen employed. An 
idea of the appearance of the nebula produced may be 
inferred from the exclamation of a boilermaker of this 
city, for a friend of whom I was employing an opiate 
solution at ordinary temperature. He saw me take the 
cold water from a drinking pitcher and add it to the 
medicated solution, and, after watching the play of the 
spray for a few seconds, he burst out, " Well, Doctor, 



22 



NEBULIZED MEDICAMENTS 



I'll be hanged! that's the first time I ever saw any one 
get up steam out of cold water !" 



Fig. 3.* 




This apparatus (Fig. 3) is composed of a glass re- 
servoir c, in which the liquid to be employed is poured 
through the little funnel G. On compressing the air 
in the pump B, by motion of the lever A, the fluid is 
forced through a small groove in one of the plates 

* A, lever; B, condensing syringe; C, glass reservoir; D, joint 
in which there is a groove through which the stream escapes ; E, 
metallic drum, against the concave surface of which the stream 
becomes nebulized ; F, waste pipe ; (x, funnel for entrance of 
fluid ; H, screw regulating the delicacy of the escaping current of 
fluid. 






AND THE APPARATUS FOR THEIR PRODUCTION. 23 

forming the joint D, and, by turning the screw H, the. 
smooth plate is more or less compressed against the 
groove, thus regulating the fineness of the stream. A 
stream as fine as the finest hair can be thus secured if 
the instrument be properly constructed. This stream 
strikes against the upper portion of the cylindrical me- 
tallic drum E, whence it is diffused in a very fine spray. 
A waste-pipe F, conveys the excess of fluid back into 
the reservoir. The force with which this little appa- 
ratus works can be seen by removing the drum, when 
the stream will be projected up for several feet, then 
falling like a fountain. It is said that at a few inches 
distance the stream can be projected into the skin, thus 
forming a mode of endermic medication. 

All these apparatuses are composed entirely, or in 
great part, of metal, which limits their ^employment to 
such articles as will not chemically react upon them. 

This objection is overcome by the very admirable 
apparatus of Lewin, of Berlin (Fig. 4), which combines 
the Sales-Girons' principle of the suddenly-arrested 
stream, and the Nathanson principle of the distributing 
current of air. It consists of a strong glass reservoir 
of the capacity of one-fourth gallon, and graduated in 
ounces. It is covered by a strong metal cap, in which 
there are three openings : one for the introduction of the 
liquid and the subsequent attachment of the condensing 
syringe ; one affords exit to the capillary extremity of 
a slender tube which reaches to the bottom of the glass ; 
and the third is covered by a spring safety-valve, through 
which the compressed air may escape after a certain 
pressure has been produced. The finger is placed upon 
the capillary extremity of the exit tube until the air in 
the reservoir has been sufficiently compressed by a few 



24 



NEBULIZED MEDICAMENTS 



strokes of the piston, when the finger is removed, and 
the fluid rushes out with great force and breaks upon a 
gilded metallic convex button secured in a glass drum, 



Fig. 4.* 




Lewin's Glass Nebulizer. (From Lewin.) 

perforated to admit the stream, and attached by a sup- 
port to the side of the instrument. The drum is not 
furnished with a waste-pipe, but is so inclined that the 
excess of fluid will flow over its edge into any con- 
venient receptacle. 

The advantages of this instrument are, that the medi- 
cinal solution comes in contact only with glass, or with 
the gilded button, and therefore any substance desired 
can be nebulized with it ; that the amount of fluid 
nebulized, as well as the quantity remaining, can be 



* a, condensing syringe ; b, reservoir; c, exit tube; d, drum. 



AND THE APPARATUS FOR THEIR PRODUCTION. 25 

accurately measured ; that twelve or fifteen strokes of 
the piston is sufficient to secure the escape of fluid for 
several minutes, thus avoiding the labor of frequent 
pumping during inhalation. 

The great objection to the apparatus is its extrav- 
agance with the liquid. Where economy is no object, 
it is the most convenient instrument for office use. 
If there be allowed to remain in the reservoir any solu- 
tion which may undergo change, or in which a precipi- 
tate may form, the capillary tube may become clogged 
up, and thus either stop the exit of the fluid entirely, 
or deflect the stream so that it will not impinge upon 
the lens. The exercise of care is necessary, therefore, 
to keep the instrument clean, and to avoid following its 
use with one medicine, by the use of another which may 
cause a precipitate. 

In 1862, Dr. Bergson constructed a nebulizing ap- 
paratus according to a suggestion of Dr. Nathanson 
[Deutsche KtiniJc, 1863, No. 7), which depends upon a 
physical principle similar to that of Matthieu. This 
principle is, that a strong transverse current passing 
over a perpendicular tube will rarefy the air in the top 
of that tube, and thus draw up any liquid in which the 
tube may be immersed, the liquid, as it meets the cur- 
rent, being broken into spray. This principle was for- 
merly applied to the cleansing of chimney flues, and 
quite recently has been employed for pumping bilge- 
water ' from the holds of vessels, for distributing the 
water from fire engines, and for superheating steam by 
the prompt evaporation of a watery spray forced within 
a boiler. It has of late years become familiar to every 
one in our larger cities in the perfume distributors used 
by the ladies to odorize their handkerchiefs or any other 

3 



26 



NEBULIZED MEDICAMENTS 



portion of their attire ; and has been introduced into 
parlors and public places of amusement for the purpose 
of perfuming the atmosphere. It is also an excellent 
mode of distributing a disinfecting solution in the at- 
mosphere of a sick-chamber, or the wards of a hospital. 
The apparatus, as constructed by Bergson, consists 
of two tubes at right angles, placed with their extrem- 
ities together, and so joined that the extremity of the 
perpendicular tube should stand in front of the axis of 
the horizontal tube, as seen in the accompanying di- 
agram. 

Fig. 5. 




The Bergson Tubes. 



If two tubes are thus arranged, and the vertical tube 
placed in a vessel containing a liquid, and then a current 
of air be blown from the mouth through the horizontal 
tube, the transverse current will carry over with it, as 
it were, the top of the column of air in the vertical 
tube, which, of course, will force up a current of the 
liquid to occupy the space of the air ; and this continu- 
ing, the liquid will at length reach the top, and be blown 
by the transverse current into a coarser or finer spray. 



AND THE APPARATUS FOR THEIR PRODUCTION. 27 

The fineness of the spray, and, consequently, its facility 
of ingress into the respiratory tract, will depend upon 
the minuteness of the extremities of the tubes, princi- 
pally upon that of the tube dipping into the liquid. If 
the fluid is to be nebulized by the breath alone, the 
opening of the horizontal tube must not be too small, 
otherwise force enough cannot be produced. If the cur- 

Fig. 6.* 




Bergson's Apparatus with the Foot Bellows. (From Lewin. 



* a, reservoir for fluid ; b, waiter ; c, vertical tube ; d, horizon- 
tal tube ; /, flexible tubiug ; g, air reservoir ; h, rubber bellows to 
be compressed by the foot ; i, joint connecting the Bergson tubes ; 
A, nebula or spray; I, rim or cap of reservoir to which the nebu- 
lizing tubes are attached. 



28 NEBULIZED MEDICAMENTS 

rent is produced by means of a bellows, as the Davison's 
injecting syringe, the opening of the horizontal tube can 
be smaller. 

For the production of a continuous stream, an air 
reservoir must be attached to the syringe, and, for 
this purpose, Dr. Bergson adopted the arrangement 
of a rubber bellows worked with the foot, connected to 
the horizontal tube by rubber tubing, in the continuity 
of which is placed a globular elastic ball as an air res- 
ervoir. (Fig. 6.) 

Later, Dr. Andrew Clarke, of London, adopted 
smaller bulbs, so that they can be compressed by the 
hand. It seems to me that the main advantage of the 
double bulb is, that pumping is thus rendered less labo- 
rious, for I do not conceive that there is anything to be 
gained for purposes of inhalation by the production of 
a continuous stream ; at times, indeed, rather the re- 
verse, for the expiratory current regularly interrupts 
the inhalation necessarily, and may thus cause a waste 
of fluid. 

These tubes can be formed of metal, glass, or hard 
rubber. Glass tubes can usually be cleansed by an acid 
bath, or by nebulizing through them a dilute mixture 
of sulphuric or muriatic acid and water, and then soak- 
ing them in pure water. If they become clogged, the 
best way to free them is by suction with the mouth at 
the larger end, so as to draw the obstructing matter 
back from the small end of the tube. If this does not 
suffice, or they become clogged while in use, a camel's- 
hair pencil, or a bristle, or a fine metallic wire, may be 
employed. A needle will be apt to break off" the fine 
points. The tubes may be formed by drawing out glass 
tubing over the flame of a spirit or gas light, and then 



AND THE APPARATUS FOR THEIR PRODUCTION. 29 

separating them by a scratch with the blade of a knife ; 
and if they are so joined that the points bear the rela- 
tion to each other shown in Fig. 5, they will work all 
right. If the end of the perpendicular tube be below 
the axis of the horizontal tube, the current will pass 
over it without impinging sufficiently to take the head 
off of the air in the vertical tube ; and if it be too high, 
the current will pass to the side, or perhaps pass down 
the vertical tube, and cause the fluid to bubble up in the 
vessel. If the perpendicular tube be bent so as to run 
under the horizontal tube before dipping down into the 
liquid (see Fig. 9), the tubes can be nicely adjusted by 
cord or small sections of gum tubing. I was in the 
habit of forming tubes in this manner for some time 
before I was aware that the modification had already 
been adopted by Prof. Winterich, of Berlin, and for 
the same purpose, that of gaining readier access within 
the cavity of the mouth. Indeed, the idea soon sug- 
gested itself to everybody of turning these tubes after 
properly adjusting their points, so as to gain access to 
any desired point; and they have been curved into 
douches for the nares, anterior and posterior, the lar- 
ynx, the bladder, the uterus, &c. 

Dr. Lewin has constructed a very convenient pocket 
nebulizer after the pattern of Bergson. The rectangu- 
lar tubes are made of metal or of vulcanized rubber, 
and joined by a hinge, so that when not in use the two 
tubes fold one upon the other, and take up but very 
little space. This is intended for use, as occasion may 
require, by blowing through the horizontal tube with 
the breath ; but such a method is rather applicable to 
other purposes than those of inhalation, for the idea of 
another's breath being blown into one's mouth is dis- 

3* 



30 



NEBULIZED MEDICAMENTS 



agreeable. To those who care to employ this method, 
I would suggest the attaching of a few inches of rubber 
tubing to the horizontal tube, so as to avoid close con- 
tact with the face of a patient, and to render the neces- 
sary effort less laborious. 

Dr. Mans {Deutsche Klinik, June 16, 1866, p. 224) 
has made an improvement on the construction of these 
tubes of Bergson, which I have found to give at each 
compression of the pump an amount of spray almost 
incredible to one who has not seen it, and with very 
little effort, which, though not more advantageous than 
the original tubes for purposes of inhalation, inasmuch 
as these latter produce spray enough, I have found ex- 
tremely useful in cases of pharyngitis where I wished 
to employ the spray as a substitute for the gargle ; and 
this especially in the throat troubles of young children, 
where the instrument which will do the most service in 
the shortest space of time is quite a desideratum. 

In this modification, the apparatus is made out of 
three tubes instead of two. The third tube communi- 
cates with the horizontal tube, and runs down behind 
the perpendicular tube the depth of a cork, in which 
the two vertical tubes run. Now, when the medicine 
vial is tightly corked, part of the transverse current 
presses on the surface of the liquid, and forces it up 
the perpendicular tube which dips into it, and thus the 
force that in the original tube is exhausted in producing 
the vacuum in the vertical tube, is reserved for the pro- 
duction of spray. I have had instruments thus ar- 
ranged, duck-billed, after the manner of Winterich, 
and then curved so as to point to any desired portion 
of the pharynx, the whole of which, if desired, can be 
douched by a single pressure of the bulb. 



AND THE APPARATUS FOR THEIR PRODUCTION. 31 

The spray producer of Dr. Richardson, of London, 
introduced for purposes of local anaesthesia, is con- 
structed upon the same principle as Mans' modification 
of Bergson's tubes, but upon a different model. In 
both Mans' and Richardson's instrument the pressure 
continues for some moments after each compression of 
the bulb, which is not the case in the Bergson tube. 

Bergson has named his apparatus a Hydrokomion, 
the same name applied in 1829 by Schneider and 
Rudolf Walz to a sort of shower-bath apparatus, con- 
sisting of a reservoir containing water, the air over 
which was compressed by a pump, and the fluid was 
driven out through many fine openings. This last-men- 
tioned apparatus, however, was never intended for res- 
piratory purposes. 

The nebulized current from the Bergson apparatus is 
more powerful than that from apparatus on the Sales- 
Girons principle, and it can be at once directed into 
the mouth. It is therefore most suitable to diseases of 
the fauces, pharynx, base of tongue, and lingual surface 
of the epiglottis. For the deeper structures, the other 
instruments, the spray from which merely hangs sus- 
pended in the air, are more suitable, as they are less 
likely to elude the current of inspiration. 

Lewin, in conjunction with Bergson, constructed an 
attachment to his apparatus already described, by which 
the same instrument could be employed on the Berg- 
son principle, and thus answer every indication. The 
drum and lens is removed from the apparatus (Fig. 4), 
and a rod and rings attached, supporting a gradu- 
ated glass tube terminating below in a very fine open- 
ing, placed directly in front of the capillary opening of 
the tube dipping into the reservoir. The glass tube is 



32 



NEBULIZED MEDICAMENTS 



filled with the solution to be nebulized, and drips by- 
gravity in front of the other opening. The reservoir 
contains nothing but air, and as this is compressed the 
current escapes, and the nebulization is thus produced. 
It is really Bergson's tubes upside down. 

In May, 1865, I exhibited to the Surgical Section of 
the American Medical Association a portable instrument 
(Fig. 7), in which I had turned the Bergson tubes as 
modified by Winterich upside down, and screwed a little 
reservoir on to the large extremity of the perpendicular 
tube, so as to make use of the same principle of gravity. 

Pig. 7. 




Bergson's Tubes reversed, with the reservoir on top. 



Where glass tubes are employed, the extremity of the 
perpendicular tube is blown out into a reservoir (see 
Fig. 9). If the fluid drips down too fast, and that it 
will drip is an objection to the instrument, rendering its 
employment inelegant at certain times, it can be regu- 
lated by the insertion of some porous material, or in 
the metallic reservoir by diminishing the size of the 
opening through which the fluid drops into the tube. 



AND THE APPARATUS FOR THEIR PRODUCTION. 33 

This instrument is very useful in many cases. Patients 
can manage it themselves ; if of glass can readily ad- 
just the extremities of the tubes so they will work ; 
and in applying nebulized fluids to the pharynx, &c, 
the vessel containing the fluid does not obstruct the 
view into the mouth. 

In all these apparatuses thus described, with the 
exception of the Eeichenheim-Waldenburg instrument, 
the spray, as it emerges, is too cold for general use in 
acute affections, unless the fluid employed is first 
warmed, or the spray produced and passed over a spirit- 
lamp, as in the apparatus of Matthieu, Fig. 2. 

It was, therefore, a happy idea of Dr. Siegle, of 
Stuttgart, to employ steam as the motive power with 
the Bergson tubes, instead of compressed air, thus 
saving to the patient the necessity of an assistant, or 
the labor of frequent pumping, and securing a more 
constant nebulizing force than can be produced by the 
pump, from which the force gradually diminishes unless 
renewed. 

Siegle attaches the horizontal tube to a small boiler 
in which water is placed, and as the steam evolved 
escapes through the tube, it creates the transverse cur- 
rent necessary to draw T the fluid from the reservoir up 
the perpendicular tube, and then nebulizes it in the 
manner already described. The only possible objection 
to steam as a motive power is that the nebulized fluid 
is always mixed with a certain amount of steam, which 
it is possible, but hardly probable, might sometimes 
prove objectionable. The largest portion of the steam 
escapes in the surrounding atmosphere ; very little is 
mixed with the spray ; too little to prove objectionable. 
How small this quantity is will be shown hereafter. 



34 NEBULIZED MEDICAMENTS 

Another motive power which has been applied to this 
purpose during the past year, is the evolution of car- 
bonic acid gas from a mixture placed in a vessel to 
which the horizontal tube is attached. This is the idea 
of a young French physician, whose name I cannot re- 
call. 

Dr. G. J. Arnold, of Roxbury, describes {Boston 
Med. $ Surg. Jour., Dec. 27th, 1866, p. 434) an appa- 
ratus in which he employs hydrostatic pressure as the 
propelling power. The horizontal tube of a Bergson 
apparatus is connected with the upper portion of an air 
reservoir by means of a stop-cock and rubber tubing ; 
at a higher elevation is placed another reservoir filled 
with water ; as the water from the latter flows into the 
lower portion of the air reservoir, the air within it is 
compressed, and when sufficient pressure has been ob- 
tained, the stop-cock is opened, and the compressed air 
escaping through the horizontal tube, produces the 
nebulization. 

Siegle's boilers are made either of metal or of glass, 
and each one, before it leaves the manufacturer, is tested 
to bear a pressure of two atmospheres. The boiler is 
furnished with a safety valve to avoid explosion, and 
with one of Collardeau's thermo-barometers, gauged to 
two atmospheres, in order to designate the pressure, 
which is regulated by raising or lowering the flame of 
the lamp by means of a screw acting on the wick. A 
stand sliding on the outside of the apparatus sustains 
the reservoir of the fluid to be nebulized by it ; and 
below this another stand supports a small spirit-lamp, 
in order to raise the temperature of the liquid in 
the vessel above if necessary. For office use the appa- 
ratus may be furnished with a gas lamp, which is more 



AND THE APPARATUS FOR THEIR PRODUCTION. 35 

convenient and less expensive, and a large boiler can 
be made to receive several sets of the Bergson tubes, 
so that separate tubes may be employed for nebulizing 
such solutions, as of tannin, chloride of iron, &c, which 
are likely to form precipitates with other solutions. 

The most convenient form of Siegle's apparatus is that 
figured in the accompanying cut (Fig. 8) ; the whole in- 

Fig. 8. 




Siegle's Steam Nebulizer. 

closed in a metallic case, which still further lessens the 
danger of bad results from an explosion. The hori- 
zontal tube passes down by an elbow into the boiler 
through a tightly fitting rubber stopper ; and the cork 
stopper in the opening through which the water is intro- 
duced does away with the necessity of any further safety 
valve. The thermo-barometer is gauged to two atmos- 



36 NEBULIZED MEDICAMENTS 

pheres, but the apparatus will be set in action with a 
pressure of one-half atmosphere. The stronger the 
pressure the more rapid the escape of steam, and the 
more rapid the nebulization, and the stronger the pro- 
pulsion of the spray. The desired pressure can, there- 
fore, be readily maintained by controlling the height of 
the flame beneath the boiler. 

Various modifications of Siegle's Steam Hydroko- 
mion have been made by Lewin, Fieber, Beigel, and 
many others, but they are all on the same principle, 
and possess no advantage over his. 

In all these forms in which the horizontal tube is bent 
so as to dip down into the boiler, every now and then, 
especially soon after the apparatus is set in action, the 
steam condenses at the curve, and as this is driven out 
by the steam behind, it spurts out hot water, which is 
sometimes projected into the face or eyes of the patient 
with very unpleasant results, and sometimes renders 
them unwilling to continue the inhalation. This can be 
in great measure avoided by passing the horizontal tube 
directly into the boiler at the side close to the top, and 
thus avoiding the curve where the steam condenses. 
This is the form of instrument that I am in the habit 
of employing, with the duck-bill form tubes, ^vhich per- 
mit of their being introduced within a mouth speculum, 
and thus avoiding considerable loss of spray. No safety 
valve is considered necessary, inasmuch as too much 
steam would force out the cork and thus escape without 
explosion. With this modification the apparatus, as 
figured in the following cut (Fig. 9), is essentially the 
Siegle apparatus, having his original arrangement of a 
lamp with a screw for raising or lowering the wick. A 
vaginal speculum introduced well into the mouth pro- 



AND THE APPARATUS FOE, THEIR PRODUCTION. 37 

tects the teeth, tongue, roof of the mouth, &c. ; and the 
tubes entering the funnel-end of the speculum, the face 




Modified form of Siegle's Steam Nebulizer, with Duck-bill Tubes. 

and clothing are thus protected, a very desirable pre- 
caution in the inhalation of solutions of the nitrate of 
silver, &c. The condensed liquid, as it flows over the 
funnel extremity of the speculum, is directed into an 
appropriate receptacle, so as to protect the clothing and 
furniture. The instrument, with all its appurtenances, 
can be obtained of Mr. Gemrig, the well-known surgi- 
cal instrument maker, of this city. 

Some of these funnels have a tube below to which a 
piece of tubing can be attached, and thus act as a 
waste-pipe to direct the excess. A very convenient 
combination of this kind with the funnel or face pro- 
tector attached to the apparatus, has been constructed 
by Dr. William Read, of Boston, which, as seen in 

4 



38 



NEBULIZED MEDICAMENTS. 



the accompanying figure (Fig. 10), is very compact, and 
can be readily carried about securely packed in the tin 
box employed as a stand when the instrument is in use. 



Fig. 10. 




Dr. Beigle, of London, also has constructed a very 
useful face protector, a sort of concave plate with a cen- 
tral aperture through which the spray passes, placed 
in front of. the mouth of the patient. 

Dr. Beigle has also devised an admirable little 
pocket steam apparatus suitable for travellers who de- 
sire to continue this method of medication. 

Lewin and some others prefer the horizontal tube to 
be of metal, with a holder in which slides the glass tube 
intended to dip into the medicated fluid. This is an 
improvement, as the risk of breaking the horizontal 
tube is avoided ; and if the glass tube become broken 
it can be readily replaced by another, and easily ad- 
justed. 



CHAPTER II. 

EXPERIMENTS UPON MEN AND ANIMALS AS TO THE PENE- 
TRATION OF NEBULIZED FLUIDS INTO THE RESPIRA- 
TORY PASSAGES. 

The report of Sales-Girons to the Academy of 
Medicine of Paris, as to the results obtained in his 
inhalatorium, caused a great sensation among the medi- 
cal profession; and numerous experiments were insti- 
tuted under different auspices, and with certain predi- 
lections in favor of the new method or against it r to 
determine whether the nebulized fluids really pene- 
trated into the respiratory tract, and if so, to what 
extent. 

At first the number of these investigations was 
limited because the experiments had to be carried on 
at the establishments where the method was being em- 
ployed; but as soon as Sales-Girons invented his 
portable instruments, investigation was further stimu- 
lated, and being rendered more convenient of execu- 
tion, a great number of observers became engaged in 
the pursuit. The results of these experiments were 
duly published in the leading French journals, and as 
the subject spread outside of France, in other Euro- 
pean journals. They have been recorded with more or 
less detail in the works of Waldenburg [Die Inhala- 
tionen der zerstaubten Miissigkeiten, so wie der Dampfe 



40 EXPERIMENTS AS TO PENETRATION 

und Gase, &c, von Dr. L. Waldenburg, Berlin, 1864), 
Fieber (Die Inhalation Medicamentbser Flussigkeiten, 
&c, von Dr. Friedrich Fieber, Wien, 1865), Lewin 
(Die Inhalations- Therapie, &c, von Dr. Georg Lewin, 
Berlin, 1865), and others, and alluded to by every one 
who has written on this subject. As they are interest- 
ing and instructive, some account of them will be given 
here. 

Experiments with Negative Results. 

Prominent among observers reporting negative re- 
sults, was Prosper de Pietra-Santa, physician at 
Eaux-Bonnes, whose experiments were performed, partly 
in the presence of Poggiale, who had been appointed 
by the Academy to prepare a report on the subject, 
in an inhalatorium arranged at Eaux-Bonnes, according 
to the principles of Sales-Girons. 

He experimented upon a goat, upon three rabbits, 
and upon himself and another observer (L' Union Medi- 
cate, 1861, Nos. 43, 44, and 59 ; Gazette Medicate de 
Paris, 1861, Nos. 14 and 15). 

He caused a young goat to breathe, for a quarter of 
an hour, an atmosphere loaded with the nebulized 
mineral water of Eaux-Bonnes, to which a small quan- 
tity of common salt had been added. The animal was 
then killed, and a solution of nitrate of silver applied 
to the larynx and bronchi, but without evincing any 
reaction. 

He caused a rabbit to breathe a nebulized solution 
of sulphate of iron from the Sales-Girons apparatus, 
for a period of twenty minutes. The application of a 
test of cyanide of potassium failed to detect any iron 
in the lungs or in the larynx; but succeeded in the 
isthmus of the fauces, on the soft palate, and in one 



OF NEBULIZED FLUIDS. 41 

portion of the oesophagus ; the latter probably because 
the animal had swallowed some of the fluid. 

He held two rabbits within a short distance of the 
spot where the fluid was nebulized in the inhalatorium 
of Eaux-Bonnes. The animals were killed, and the 
test applied with nitrate of silver and with acetate of 
lead, but without evincing the slightest trace of reac- 
tion in the respiratory organs. 

M. Prosper de Pietra-Santa read his memoir before 
the Academy of Medicine, October 8, 1861 (Gazette 
Hebdomadaire, 1861, p. 659), coming among other 
conclusions, as the result of his clinical observations 
and experiments, to the following : — that the nebulized 
mineral waters do not penetrate into the bronchi ; that 
a considerable depression of temperature is produced 
at the moment of nebulization ; that a very consider- 
able desulphurization takes place in the nebulization 
of these mineral waters ; and that the temporary alle- 
viations observed, are due to the inspiration of the dis- 
engaged hydro-sulphuric acid gas. 

Rene Briau, physician at Eaux-Bonnes (Gazette 
Hebdomadaire* 1861, No. 15), at the laboratory of 
the College of France, placed at his disposition by 
Prof. Claude Bernard, on 31st January, caused a rab- 
bit to breathe for twenty-two minutes close to the drum 
of a Sales-Girons apparatus, the nebulized spray of 
two litres (a litre is 1.0567 quarts) of a solution of cy- 
anide of potassium, the animal remaining tranquil and 
breathing the whole of the liquid. Immediately after, 
the animal was killed by section of the spinal cord. 
The test of a solution of the sesquichloride of iron was 
applied, and detected the presence of the cyanide salt 
in the larynx, in the trachea, and in the larger and 

4* 



42 EXPERIMENTS AS TO PENETRATION 

smaller bronchi. Prof. Claude Bernard, who, with MM. 
Vella and Leconte, witnessed this experiment, raised 
the objection that the substance employed is very 
readily and very rapidly absorbed into the blood, and 
that this fact could account for its presence in the 
respiratory tract; and, at his suggestion, the urine, 
ureters, and kidneys were also tested, and the same re- 
action took place. Briau, therefore, did not consider 
the experiment conclusive. Lewin (op. cit., p. 163), in 
commenting upon this experiment, very judiciously ob- 
serves that the absorption into the system might have 
taken place through the delicate mucous membrane of 
the respiratory organ. 

Then reversing his experiment, Briau caused a rabbit 
to inhale a solution of the chloride of iron (a salt ab- 
sorbed with difficulty by the animal tissues) during 
twenty-six minutes ; and the reaction gave again a posi- 
tive result. 

The 6th of February following, a small dog was held 
close to the drum and breathed tranquilly, for twenty- 
five minutes, an atmosphere in which two litres of the 
solution of the perchloride of iron was nebulized. In 
this case the test could detect no trace of the salt ex- 
cept in the mouth, the nostrils, and the pharynx. He 
then performed the same experiment with another dog, 
employing the solution of the cyanide of potassium by 
inhalation, and the iron salt as the test. Surprised at 
the different results on two species of animals so closely 
related, he immediately repeated his experiments upon 
another rabbit, and on applying the test, in a few 
minutes the characteristic reaction occurred in the 
whole extent of the bronchial tree. 

Finally, Prof. H. Bouley (d'Alfort) placed at his 



OF NEBULIZED FLUIDS. 43 

disposal a horse, who had a carcinomatous tumor of the 
stomach; and on the 18th of February, with the assist- 
ance of M. Raoux, he experimented on this animal at 
the veterinary college. The horse, whose respiratory 
organs were intact, was placed horizontally with his 
head on the same plane as the rest of his*body. The 
experiment lasted an hour and a quarter, forty-five 
minutes being consumed in the inhalation of four litres 
of a solution of the sesquichloride of iron. After the 
animal was killed by section of the spinal marrow, the 
fluid which had been inhaled was detected in the nos- 
trils, but there was no evidence of its having penetrated 
into the bronchi, the trachea, or the larynx. Briau 
concludes that he can account for the success with the 
rabbits on account of the proximity of their glottis to 
the mouth, and that the fluid in condensing on the pos- 
terior walls of the pharynx flows down into the larynx 
and trachea. In this view he is sustained by Prof. 
Claude Bernard. 

Champouillon (Gazette des Hopitaux, 1861, No. 66) 
directed an invalid to breathe, for half an hour, a solu- 
tion of the chloride of iron. After the mouth had been 
thoroughly rinsed, the sputa were tested with cyanide 
of potassium, but no reaction was produced. 

Delore (Gazette Medicate de Lyon, 1861, September 
1st and 1 6th) caused several individuals to inhale neb- 
ulized solutions containing iodide of potassium, and 
tincture of iodine: but found no trace of iodine either 
in their urine or in their saliva. 

Armand Rey (L' Union Medicate, 1861, No. 139) 
desired to employ an atmosphere more profusely loaded 
with spray or nebula than could be produced by the 
apparatus of Sales-Girons, and he constructed an ap- 



44 EXPERIMENTS AS TO PENETRATION 

paratus by means of which the capillary jets of water, 
projected by a vertical pressure of fifteen metres, were 
received perpendicularly upon the palettes of a hori- 
zontal turbine, very rapidly rotated in the direction 
opposite to that of the jets. He thus produced a very 
dense spray, but the whole of the water did not nebu- 
lize, a portion of it spurted about unpleasantly. To 
control this dashing he inclosed the apparatus in a wide- 
meshed net, but to his astonishment it caught the whole 
amount of the spray, which it condensed, and did not 
permit the slightest particle to pass through. Then he 
employed pasteboard, in which he made openings of the 
size and form of the human glottis, and again the whole 
of the spray was caught and condensed. 

Then he instituted some experiments upon animals, 
the results of which were negative. 

The cause of these obstructions he attributed to the 
circumstance that these sprays are merely suspended 
in the air, and that therefore, as soon as any impedi- 
ment interfered with their slight impulse, the nebulized 
particles immediately collected and condensed into 
drops. Thus the inner surface of the cheeks, the roof 
of the mouth, palate, &c, being such impediments, they 
detain the spray, which falls in drops without gaining 
entrance into the larynx. But, as Lewin observes (p. 
177), he seems to have overlooked the fact that in in- 
halation the inspiratory current as it passes into the 
lungs will deflect these light particles as they play in 
the atmosphere, and direct them towards the middle 
line of the open glottis, so that they will describe a sort 
of curve in their passage. 

Edouard Fournie was the most persistent opponent 
to the new method, and exercised a remarkable degree 



OF NEBULIZED FLUIDS. 45 

of ingenuity in devising crucial experiments to put to 
the utmost test the theory that the nebulized medica- 
ments penetrated into the air-passages. [Proceedings of 
Academie des Sciences, 1861 ; Gazette Hebdomadaire, 
1861, p. 626 ; Gazette des Hopitaux, 1862, No. 9.) 

At a stance of the Academie des Sciences, held Sep- 
tember 16th, 1861, he read extracts from a work of 
his, entitled, " Memoire sur la penetration des corps 
pulverulents, volatils, gazeux, solides et liquides, dans 
les voies respiratoires au point de veu de l'hygiene et 
de la therapeutique," in which he details his various 
experiments. 

In order to test the mechanical feasibility of such 
penetration, Fournie constructed an artificial respira- 
tory apparatus. He bent at right angles a tube twenty- 
five centimetres long and two centimetres in diameter, 
and placed it through one of two openings in a flask, so 
that it dipped into a solution of sulphate of iron, with 
which the vessel was half filled. The free extremity of 
this tube terminated in a wide mouth-piece, which might 
represent the oral cavity. The other opening commu- 
nicated, by means of rubber tubing, with the nozzle of 
an exhausting syringe furnished with a delicate valve 
which would open as soon as the force exceeded that of 
the inspiratory force of the lungs of a strong healthy 
man. He filled a Sales-Girons apparatus with a solu- 
tion of the cyanide of potassium, and placed it at ten 
centimetres distance from the mouth-piece of the appa- 
ratus ; and at the same time that the nebulizer was put 
in action, the exhausting syringe was placed in action 
rhythmical^with the duration and strength of ordinary 
human inspiration. 

Although the fluid was thoroughly nebulized, the 



46 EXPERIMENTS AS TO PENETRATION 

solution of sulphate of iron did not change color in the 
least. From this experiment Fournie came to the con- 
clusion that he had demonstrated that the solution of 
the cyanide of potassium could not be made to enter the 
flask. 

At a later date he instituted a different experiment. 
Having detached from a recent cadaver, a human larynx 
with the tongue, epiglottis, and pharynx, he attached 
to this a glass tube of the diameter of the trachea. Ar- 
tificial inspiration was produced by placing in the mouth 
of the experimenter a tube of rubber attached to the 
lower end of the artificial windpipe ; and during the in- 
spiration, the glottis was held open by means of serres- 
fines attached to the posterior crico-arytenoid muscles, 
while the watery spray from the pulverisateur was di- 
rected towards the larynx. It was seen in this experi- 
ment that the larger portion of the nebulized fluid struck 
on the pharynx, and was then and there condensed. 
Another smaller portion fell down upon the epiglottis, 
which protected the opening of the glottis like a regular 
roof, and thence glided in great drops along the aryteno- 
epiglottic folds to gain entrance into the larynx. Not 
the slightest trace of the nebulized water could be seen 
upon the walls of the tube. 

This experiment was repeated with solutions sensitive 
to the most delicate chemical tests, and with similar 
negative results. 

Then Fournie experimented on himself. He took it 
for granted that if the nebulized fluids penetrated into 
the trachea and the bronchi, he ought to be able to de- 
tect their presence in the sputa expectorated immedi- 
ately after an inhalation. Suffering at the time from 
an acute attack of bronchitis, he inhaled a solution of 



OF NEBULIZED FLUIDS. 47 

arsenious acid, five grammes to five hundred grammes 
of water. He selected this material because it is less 
readily absorbed through the tissues than others, and at 
the same time can be detected by reagents when present 
in the minutest quantity. 

He placed himself within five centimetres distance 
from the opening of the apparatus, and inhaled, to the 
best of his ability, with widely opened mouth, the en- 
tire solution of five hundred grammes. The material 
expectorated during the few minutes next succeeding, 
and amounting to four grammes, were dried upon a 
platinum capsule, incinerated with nitrate of potassa, 
and the product of combustion placed in contact with 
water acidulated with sulphuric acid, according to the 
process of Marsh ; but without producing any of the 
metallic arsenical rings on the porcelain. The reaction 
ensued, however, as soon as one drop of the arsenical 
solution was added. 

A similar experiment, performed upon a young man 
laboring under a profuse specific bronchorrhoea, afforded 
the same negative result. 

On another occasion a concentrated solution of ni- 
trate of silver was inhaled through a glass tube of three 
centimetres diameter, employed in order to protect the 
mouth from discoloration. Laryngoscopic inspection, 
immediately after the inhalation, showed the posterior 
wall of the pharynx tinged with the nitrate, but the 
interior of the larynx retained its natural color. The 
sputa expectorated immediately after, showed no evi- 
dence of the inhalation. 

A young man, twenty-four years of age, who had 
worn a canula for several years, in consequence of a 
fracture of the larynx, the result of an accident, was 



48 EXPERIMENTS AS TO PENETRATION 

selected for an experiment. The condition of the young 
man's organs, as seen by the laryngoscope, was as fol- 
lows : — Above the vocal cords, everything appeared nor- 
mal ; the cords themselves were colored red, having lost 
their brilliant mother-of-pearly tint ; toward the poste- 
rior inferior third of the left vocal cord a small nodule 
was perceived, having much the appearance of a carti- 
lage. The lesion had not interfered with inspiration, 
for the arytenoid cartilages separated properly and the 
laryngeal cavity expanded in the usual manner; but 
expiration was so difficult that for its performance the 
tracheal opening was indispensable ; the closure of the 
larynx daring expiration seemed to be effected by the 
lesion in the cricoid cartilage, which had been the seat 
of fracture, as a result of which the crico-thyroid and 
posterior-crico-arytenoid muscles had become paralyzed. 
A bunch of raw cotton attached to a thread was intro- 
duced into the trachea, and the pulverisateur set in ac- 
tion. During the inhalation the canula was closed by 
the finger of the patient, which was slightly raised 
during expiration ; and the solution employed was of 
iodide of potassium five grammes to five hundred 
grammes of water. After the inhalation, the cotton 
was withdrawn and tested with starch and with sul- 
phuric acid, but afforded no reaction. 

A similar experiment was performed upon one of the 
female nurses of the Hospital Beaujon, who also wore 
a canula in her trachea, and with the same negative 
result. 

From these experiments, Fournie' offered the follow- 
ing reasons to account for the non-penetration of the 
nebulized liquids : — 



OF NEBULIZED FLUIDS. 49 

1st. The divergence of the watery particles in issuing 
from the apparatus. 

2d. The propulsion of the current from the apparatus 
in a straight line. 

3d. The curve of the trachea. 

4th. The proximity of the soft palate to the base of 
the tongue. 

5th. The involuntary contraction of the glottis. 

6th. The irritability of the larynx. 

Finally, he draws the following conclusions : — 

1st. It is nevertheless possible, by this method, to 
induce a toxic effect upon the larynx, but one of short 
duration only. 

2d. The fluid can certainly penetrate into the air- 
passages, but not with facility, nor in sufficient quan- 
tity; and this only when the inhalation is performed 
with peculiar care, such as opening the mouth well, sep- 
arating the base of the tongue from the soft palate, with 
the head inclined backwards to destroy as much as pos- 
sible the rectangular curve that the windpipe makes 
with the oral cavity. 

In contradistinction to the difficulty or impossibility 
of inhaling fluids into the air-passages, he calls atten- 
tion to the facility with which solid powders can be 
drawn by inspiration even into the remotest bronchi, in 
proof of which he cites the various experiments in which 
he demonstrated that such powders will pass completely 
through a tube twenty-five centimetres in length and 
two centimetres in diameter, and bent at a right angle ; 
and he says that while the watery particles condense 
upon the sides of the tube, solid particles are propelled 
by successive ricochetting to the very end of the tube. 

Fournie believed the sulpho-hydrogen gas, disengaged 
5 



50 EXPERIMENTS AS TO PENETRATION 

from the therm o-sulphurous waters, to be, by its direct 
contact with the seat of lesion, one of the principal 
agents in the curation of diseases of the chest. 

Lewin (op. tit., p. 174), in commenting upon these 
experiments, calls attention to the circumstance that 
Fournie seems to have overlooked the important fact 
that the trachea and the bronchi, instead of being dry 
and smooth like the glass tubes used for experiment, 
are constantly moist, and more or less covered with 
mucus ; and that the pulverulent particles must possess 
a peculiar strength if they can ricochet over this moist 
mucus until they reach the bronchi. 

If powders penetrate into the bronchi they must be 
projected in a continuous line, for as soon as they alight 
on the moist surface they must become entangled and 
remain there. 

As Lewin says, in ignoring as conclusive Fournie"s 
experiment with the exsected larynx, in which the epi- 
glottis is placed " like a regular roof over the entrance 
of the glottis," the epiglottis does not retain this posi- 
tion during deep inspiration, as can be demonstrated by 
laryngoscopic observation ; it becomes more erect. It 
is absolutely impossible to place the larynx of a cadaver 
with its pharynx, soft palate, tongue, &c, in the posi- 
tion which they assume during life in deep and volun- 
tary inspiration. 

Experiments with Positive Results. 

The most extensive series of experiments were per- 
formed by Demarquay, surgeon to the Maison Munici- 
pale de Saute, and these it is, principally, upon which is 
based the favorable report to the Academie de Me'de- 
cine (Gazette Medicate de Paris, 1861, p. 616). 



OF NEBULIZED FLUIDS. 51 

These experiments were performed at the Maison 
Municipale de Sante in the presence of Profs. Poggiale, 
Re'veil, Gobley, and Trousseau, MM. Mialhe, See, 
Pietra-Santa, Giraud-Teulon, and the students of the 
institution ; and with the assistance of M. Leconte 
{Bulletin de V Academie, September 24, 1861 ; Gazette 
Rebdomadaire, September 27, 1861, p. 627). 

Demarquay experimented upon some eighty rabbits, 
upon a number of dogs, and upon the same female nurse 
at the Hospital Beaujon, who was made the subject of 
one of the experiments of Fournie\ 

The rabbits were caused to breathe an atmosphere 
loaded with the nebulized spray of a solution containing 
one gramme of the perchloride of iron to one hundred 
grammes of distilled water, the apparatus employed 
being that of Mathieu (and Tirman). The snouts of the 
rabbits were held forcibly open by a suitable dilator. 
The experiments continued five minutes, with a few mo- 
mentary intervals of rest. The animals had all been 
lively before the experiment ; a number of them were 
killed immediately upon the conclusion of the experi- 
ment, and the remainder were saved. Upon testing the 
respiratory organs of the slaughtered animals with a 
solution of cyanide of potassium, the presence of iron 
in a greater or less degree, and in various degrees as 
respected the individual portions of the apparatus, was 
demonstrated in the entire respiratory tract, even in 
the parenchymatous tissue of the lungs ; and, upon the 
addition of acetic acid, the blue tinging became still 
more apparent. In order that it might not be objected 
that the fluid ran down the tracts, the experiment was 
commenced at the bronchial tubes and continued up 
into the larynx. In some cases the entire bronchial 



52 EXPERIMENTS AS TO PENETRATION 

tree became blue, in others some portions of the mi- 
nutest bronchi remained uncolored. The chloride of 
iron was detected in the oesophagus and in the stomach 
in consequence of the swallowing of some of the fluid. 
Immediately after the death of the animals, and at in- 
tervals during twenty-four or forty-eight hours, sec- 
tions of lung were placed in contact with a watery 
solution of cyanide of potassium to which acetic acid 
had been added, which demonstrated the existence of 
the iron salt in the very cells of the lung. 

The animals which had not been killed were attacked 
with broncho-pneumonia, and some of them with regular 
circumscribed pneumonia, within a period of from twelve 
to twenty-four hours ; — a further proof of the penetra- 
tion of the fluid. 

Similar experiments were repeated upon dogs, and 
with similar results, except that the nebulized fluid 
was not found in the parenchyma of the lungs. 

Upon one of these dogs Demarquay performed the 
operation of tracheotomy, and then caused it to inhale 
a solution containing one per cent, of tannin. The 
wound was tightly closed during the inhalation, which 
continued several minutes, and at its close he passed 
into the trachea a piece of paper which had been moist- 
ened in a solution of chloride of iron and then dried; 
and the inky reaction soon appeared. 

In these experiments with the dogs, not only were 
their snouts kept forcibly dilated, but their tongues 
were drawn forwards by means of threads passed 
through the organ, to prevent any impediment to the 
entrance of the fluid by contact of the tongue against 
the soft palate. 

Demarquay experimented upon a female nurse in the 



OF NEBULIZED FLUIDS. 53 

Hospital Beaujon, who was compelled to wear a canula 
in her trachea. This is the same case upon whom 
Fournie' experimented with negative results. The laryn- 
geal structures were very much contracted, and the 
patient could bear the withdrawal of the canula only 
for a brief period at a time. This female inhaled as 
best she could, a weak solution containing one per cent, 
of tannin. During the inhalation the tracheal opening 
was closed by a strip of paper which had been moist- 
ened with a solution of the sesquichloride of iron, the 
paper being confined by adhesive strips, and the whole 
covered by a napkin. The mouth was placed at a dis- 
tance of twenty-five centimetres from the distributing 
tube of a Matthieu's apparatus. 

The difficulties in this case were very great from the 
condition of the glottis, the position of the wound with 
considerable depression of tissue at that point, and the 
prominence of the sterno-cleido mastoid muscles. Twice 
the experiment failed on account of the yielding of the 
paper and the adhesive plaster, and their partial de- 
tachment from the canula; but, on the third attempt, 
Demarquay kept his finger applied over the opening, 
and the strip of paper was withdrawn colored black in 
considerable extent. 

Demarquay lays great stress on the result of this 
experiment as being prominently favorable (Gazette 
Hebdomadaire, 1862, p. 391), for if a larynx so altered 
from its normal condition, as to be unequal without 
artificial aid to the admission of sufficient air to sustain 
life, would permit enough of the fluid to pass it, to be 
detected by chemical reaction, it is hard to conceive 
why a larynx in a normal condition would not afford 
much greater facility of penetration. 



54 EXPERIMENTS AS TO PENETRATION 

At the seance of the Acade*mie de Medecine of Paris, 
April 29, 1862, Prof. Trousseau exhibited several sec- 
tions of the lungs of Demarquay's rabbits in which the 
penetration of the chloride of iron could be demon- 
strated even to the minutest ramifications of the bronchi. 
Tavernier {Experiences sur la penetration dans les 
poumons des pousieres liquides tenant en dissolution des 
reactifs cliniques ou des medicaments. — G-azette Medicale 
de Paris, 1861, p. 808) experimented on himself with 
a solution of sesquichloride of iron, and cyanide of potas- 
sium. He employed the pulverisateur of Sales-Girons 
and took in long and deep breaths. First, he inhaled 
the solution of tannin, and then, that of the cyanide of 
potassium ; with each he experienced a sensation of 
cold in the chest, with some feeling of constriction, and 
a disposition to cough. After the inhalation, an ex- 
amination with the laryngoscope revealed that the 
larynx over and below the vocal cords, and the vocal 
cords themselves to a greater extent, were covered with 
a sombre layer, which was nothing else than Prussian 
blue. Then he rinsed out his mouth again and again 
until the water contained no more trace of the Prussian 
blue ; . and after that he endeavored, by hawking and 
coughing, to bring up some mucus from the trachea or 
larynx ; this, at first strongly though irregularly col- 
ored, was afterwards followed by uniformly colored 
mucus, which he had not the slightest doubt, had been 
brought up from the minute bronchi, in contact with 
the pulmonary cells. 

Prof. Gratiolet, shortly after, repeated Tavernier's 
experiments upon himself, and reported similar results 
[G-azette Hebdomadaire, 1861, p. 822). 

Bataille took advantage of a chronic inflammation 



OF NEBULIZED FLUIDS. 55 

of the mucous membrane of the respiratory organs 
under which he was laboring, and while endeavoring to 
cure this experimented on himself (Gazette Hebdoma- 
daire, 1862, p. 390). He inhaled for a time a solution 
of the extract of rhatany, and then examined the parts 
with the laryngoscope. He found the mucous mem- 
brane of the larynx and trachea colored red. After 
a few hours this color had disappeared ; nevertheless, 
during the entire day he expectorated reddish sputa. 
Bataille concluded that the medicated fluid had pene- 
trated into the bronchi, for his reddish expectorations 
were of the character designated as "bronchiques." 

Moura-Bourouillou (Gazette des Hopitaux, 1861), 
experimented on himself, and on patients, with a black 
fluid. Examination with the laryngoscope discovered 
the traces of the fluid in the larynx and in the trachea. 
His experiments upon himself he repeated in the pres- 
ence of Poggiale. Not only did he demonstrate the 
presence of the pulverized particles in the trachea, but 
also their actual entrance and passage through the 
glottis during inhalation as observed with the laryngo- 
scope (La Revue Medicate, December 15, 1861). 

Auphan experimented to discover how far liquids 
could be made to penetrate into the respiratory tract. 
With this view he injected into the trachea of a rabbit 
four drachms of a solution containing one per cent, of 
iodide of potassium. No cough was produced. In ten 
minutes the animal was killed, and he tested the trachea, 
the bronchi, and the parenchyma of the lungs without 
producing any reaction with starch. In another ex- 
periment he killed the animal immediately after its 
conclusion, and there ensued a slight reaction. Auphan 
does not doubt the penetration of fluids into the respi- 



56 EXPERIMENTS AS TO PENETRATION 

ratory tract, which, he thinks, absorbs the material em- 
ployed very promptly (G-azette Medicate de Paris, 
1861, p. 315). 

Sales-Girons performed some experiments with an 
artificial respiratory apparatus which he constructed 
out of gutta percha, with a mouth, a soft palate raised 
up, a tongue depressed so as to expose a portion of the 
posterior wall of a pharynx which was bent at an 
obtuse angle, and below it, horizontally, at a distance 
of three centimetres, was a glottis, and below the larynx, 
a glass tube represented the trachea. When this ap- 
paratus was placed before a pulverisateur and inspira- 
tion was drawn through the trachea, the liquid pene- 
trated into that tube ; but if the tube was bent into an 
angle the spray was arrested at the first angle, and fell 
below in drops of water. 

Report on the foregoing Experiments to the Parisian 
Academy of Medicine. 

On January 7th, 1862, Poggiale, as chairman of the 
committee appointed to investigate this question, made 
an extensive and very interesting report to the Aca- 
demic Imperial de Medecine of Paris, in which he re- 
viewed the whole subject critically, and in which, in an- 
swering affirmatively the question, " Do the pulverized 
liquids penetrate into the respiratory tract?" he based 
his conclusions chiefly upon the experiments upon rab- 
bits, made by himself and others, principally Demar- 
quay. He even drew positive conclusions from the ex- 
periments reported as evincing negative results ; show- 
ing that in Briau's cases the fluids were clearly proved 
to have reached the air-passages, although the animals 



OF NEBULIZED FLUIDS. 57 

had been allowed to breathe through the nose. He 
referred to the many causes of error in such experi- 
ments, arising sometimes on the part of the experimenter 
himself, who might lack the necessary chemical, physi- 
cal, or anatomical knowledge necessary for accurate 
observation; or from want of intelligence or skill of the 
assistants ; or from the nature of the apparatus em- 
ployed ; or, finally, from the manner of managing the ani- 
mals, their want of co-operation, their struggles, &c, &c. 
In alluding to the negative result from Fournie"s ex- 
periment upon the nurse at Beaujon, he showed how 
the error in that case must have arisen from imperfect 
closure of the opening of the trachea during the ex- 
periment ; for Demarquay, in his experiment with the 
very same individual, had failed twice from such a 
cause ; and not until the third attempt did the experi- 
ment succeed. Finally, he believed that the experi- 
ments of Fournie himself upon the penetration of pow- 
dered substances into the air-passages proved the 
possibility of the entrance of pulverized fluids. 

Four months later, in the discussion before the Aca- 
demy, held April 29th, Durand-Fardel, who had been 
one of the first to doubt the penetration of these fluids, 
objected to a portion of Poggiale's views, and for him- 
self came to the following conclusions : — that the fluids 
penetrated to a considerable extent in the subglottic 
region and in the trachea, but that such penetration as 
far as the bronchi had not been proved; for everything 
went to show that the traces were feebler as the parts 
were more distant from the glottis ; and that, if they 
did pass beyond the trachea, it was in such small pro- 
portion as to deprive them of «their therapeutic value 



58 EXPERIMENTS AS TO PENETRATION 

{Bull, de I'AcadSmie de Med., 1862, vol. xxvii, p. 
752). 

The discussion was continued on May 6th (idem), 
when Trousseau declared himself warmly in favor of 
the method, expressing some degree of surprise that a 
doubt as to the penetration of these liquids could be 
entertained, since the penetration of coal and other 
materials w T as a fact beyond dispute ; and upon an ob- 
servation being made by an opponent that the larynx 
is a vigilant sentinel, denying entrance to foreign 
bodies, Trousseau replied, "It is a vigilant sentinel, per- 
haps so, but one that can be taken by surprise. When 
it cries out, ' Who goes there?' it is already too late ; — 
in other words, when cough occurs, it is because the 
liquid has already penetrated into the larynx !" As 
further proof, he exhibited the lungs of a rabbit which 
had inhaled but five minutes, and in which not only 
could the penetration of the solution of the iron salt be 
demonstrated to have reached the parenchyma of the 
lungs, but further, to have left traces of the existence 
of a pneumonia excited by means of this inhaled fluid. 
" Why," said he, " the fluids may penetrate too much, 
and it is therefore a method of treatment demanding 
caution." 

Poggiale, in reply to Fournie"s objections to his 
report, replied, that the experiments on men and ani- 
mals leave no doubt as to the penetration of pulverized 
substances. The experiments of Fournie prove noth- 
ing, if compared with the results of those of Moura- 
Bourouillou. He did not object to Fournie" s results 
with his various artificial contrivances ; but contended 
that, as we have to deal with men and animals, it is with 






OF NEBULIZED FLUIDS. 59 

men and animals that we should experiment, and not 
with tubes and vessels which have not the elasticity 
nor pliability of organic tissues. In regard to Durand- 
Fardel's objection that it had not been demonstrated 
that the liquids penetrated into the bronchial tubes, he 
brought forward the cases in which its presence had 
been detected in the lung tissue ; and Demarquay's 
rabbits, in whom it had produced pulmonary inflamma- 
tion, for which reasons " the penetration into the bron- 
chial ramifications is an incontestable fact." 

Poggiale's report also included the questions as to 
the change of temperature in the pulverized fluids in 
issuing from the instrument, the chemical alteration of 
the sulphuretted waters by the process of nebulization, 
and the probable value of therapeutical results. 

The mineral waters of the various spas do undergo 
some change, but not so with artificial solutions. 

The result of the discussion was an almost unanimous 
acquiescence with the able report of Poggiale. 

Further Experiments in Germany and elsewhere. 

The widely disseminated results of the French ex- 
perimenters, to which reference is made in the pre- 
ceding pages, soon stimulated similar investigation in 
other portions of the continent, and we have recorded 
the researches of various observers in Russia, in Ger- 
many, and in Spain. 

Dr. Friedbjch Fieber, of Vienna, was the first to 
introduce the new method into Germany, and with the 
assistance of his brother, Dr. Carl Fieber, he repeated 
Demarquay's experiments on rabbits and upon an in- 
dividual with a tracheal fistule. These experiments 



60 EXPERIMENTS AS TO PENETRATION 

were repeated before Prof. Schroff, and confirmed the 
results of the French observer. 

His experiment upon the individual who had under- 
gone tracheotomy differed somewhat from that of De- 
marquay upon the nurse at the Beaujon Hospital [Die 
Inhalation Medieamentbser FliissigJceiten, <Jn?., p. 44). 
This patient was a shoemaker, aged twenty-two years, 
of strong frame and healthy lungs, who had been re- 
ceived on September 11th, 1861, in the wards of Herrn 
Primarius Kolisko, and who was under treatment for 
typhus. 

October 3d, he was seized with dyspnoea, which, 
within a few days, increased to such an extent that on 
the 9th instant he was transferred to the surgical wards, 
where, on the 11th, the operation of laryngotomy was 
performed. The patient recovered gradually, but was 
not able to dispense with the canula. 

Some three weeks after the performance of the opera- 
tion, an attempt was made to withdraw the canula for a 
few moments, but it had to be promptly returned, and 
even an experiment made to see how long he could bear 
a closure of the fistule could not be endured longer than 
from twenty to thirty seconds. 

On the 1st day of January, 1862, Fieber undertook 
to repeat upon this man the experiment of Demarquay, 
and the effort was attended with difficulties fully as 
great as those of his Parisian prototype. In the present 
instance the difficulty lay less in a contracted glottis, 
and a strongly projecting sterno-cleido-mastoid, than in 
the want of intelligence on the part of the patient, who, 
in addition, was excessively timid, and could not make 
up his mind to submit to the inhalation until Fieber had 



OF NEBULIZED FLUIDS. 61 

himself inhaled before him. Even then he breathed 
with so much dread that the first two attempts re- 
mained fruitless ; but the third attempt, at which he 
was rather more skilful, gave a positive result, though not 
to a very satisfactory extent. At the fourth trial, how- 
ever, the result was more or less similar to that obtained 
by Demarquay. Fieber employed one of Charriere's 
apparatus instead of one of Matthieu's, as Demarquay 
had done, and the solution experimented with contained 
two per cent, of tannin. He did not place within the 
opening a piece of paper as a test, but saturated a strip 
of linen with the solution of the perchloride of iron, and 
the finger alone was sufficient to close up the opening. 
Fieber regrets very much that, on account of the many 
difficulties with which it was attended, he was compelled 
to forego a laryngoscopic examination at the conclu- 
sion of the experiment. 

Tobold {Deutsche Klinik, 1862, p. 211) exhibited at 
the meeting of the Berliner Medizinischen Gesellschaft 
the lungs of rabbits upon which he had repeated the ex- 
periments of Demarquay, and with similar positive re- 
sults. 

Schnitzler and Stork ( Wiener Medicinalhalle, 
1862, No. 46; Fieber, p. 50; and Wochenblatt der 
aesellschaft der Aerzte, 1862, No. 45; Lewin, p. 183) 
experimented upon the servant of Dr. Stork, with 6ol- 
o-red solutions, of rhatany, Campeachy-wood, saffron, 
&c. ; and upon laryngoscopic examination, to which the 
individual was thoroughly accustomed, the coloring 
could be detected far down the larynx, and in one in- 
stance could be followed. into the trachea. 

These gentlemen also repeated the often-cited exper- 
iment of Demarquay, upon an individual who had under- 

6 



62 EXPERIMENTS AS TO PENETRATION 

gone tracheotomy some eighteen months previously, on 
account of the presence of some syphilitic tumors. The 
method of experiment was that already detailed in con- 
nection with Fieber's case. The first two trials failed, 
but the third, fourth, and fifth succeeded, the patient 
inhaling more quietly and deeply, and the strength of 
the solution being increased from one grain to five to 
the ounce. 

The same experiment was then repeated with a dilute 
solution of iodine, only the linen was not placed imme- 
diately in the tracheal opening, but was fastened to a 
probe and introduced concealed within a thin tube, so 
that having been pushed forward and brought in con- 
tact with the tracheal mucus, it could be removed again 
concealed within the tube; the fragment then placed in 
a strong solution of starch assumed the light blue color. 
Twice the experiment succeeded; a third time it failed. 
These gentlemen also repeated Sales-Girons' experi- 
ments with an artificial respiratory apparatus, and with 
confirmatory results. (Fieber, p. 50.) 

Lewin (Die Inhalation s-Therapie, Berlin, 1865, p. 
183) contributes five experiments; the first two of which 
were performed in the presence of Prof. Virchow. 

1. A middle-sized dog, bound in a towel, was held by 
one servant, and while another servant held the snout 
open, the animal was made to breathe the spray of a 
solution (1 : 100) of the perchloride of iron from a 
Mathieu Nephogene, great difficulty being encountered 
in holding the animal so that the spray could be kept 
directed into his mouth, for he would forcibly turn his 
head sideways so as to keep his muzzle out of the line 
of the current. After the nebulization of twelve ounces 
of the fluid, the animal, whose eyes had become quite 



OF NEBULIZED FLUIDS. bZ 

bloodshot in his efforts to free himself, was killed by 
section of the spinal cord. 

The peculiar black reaction with tannin could be dis- 
tinguished on the soft palate, the posterior pharyngeal 
wall, the posterior surface of the epiglottis, and at 
various spots in the trachea, principally on the lateral 
walls ; but not at all in the bronchi or in the paren- 
chyma of the lungs. 

2. A more powerful animal was selected this time, 
and the following device was pursued to manage more 
easily the head and snout of the animal, and to secure 
a more favorable position for the experiment : One side 
of a chest was so cut out that when closed over the 
neck of the animal it was completely encircled, the head 
within the box ; in the opposite side of the box the 
delivery tube of the apparatus was admitted through a 
suitable opening, and through another small aperture, 
Lewin watched the effect. The interior of the chest 
was soon filled with the nebulized spray, but the dog 
forced his snout downwards to such a degree that the 
penetrating particles of the fluid were principally re- 
ceived upon his nose and the upper part of his muzzle, 
and here condensed without at all entering the mouth. 
The examination, upon killing the animal directly after 
the experiment, gave a negative result in the larynx 
and in the trachea. 

3. A powerful rabbit was made to inhale six ounces of 
a solution of chloride of iron (2 : 100) at a distance of 
one foot from the apparatus, the muzzle being forcibly 
dilated. This animal also was very restless, as were all 
the animals with which Lewin experimented. The 
tongue was allowed to remain quietly in the mouth, 
and it was observed to lay with its base so much in 



64 EXPERIMENTS AS TO PENETRATION 

contact with the posterior wall of the pharynx as to 
occlude the entrance into the larynx. 

On examining the slaughtered animal, the fluid em- 
ployed was chemically detected upon the upper surface 
of the epiglottis, on the lateral borders of the lower 
surface, and upon the protrusion at the thyroidal at- 
tachment of the epiglottis ; but not in the trachea. 

4. The same experiment was repeated with another 
strong rabbit, the nostrils being compressed and the 
muzzle held open, and with the same result. 

5. The same experiment was performed upon a fee- 
ble rabbit, which could be so held that the hands did 
not compress the abdomen and thus impede the respi- 
ratory process, as was the case with the other animals. 

In this case, the fluid could be detected beyond the 
bifurcation of the trachea, but not far, and only with 
slight traces. 

In all his examinations upon the cadavers of these 
animals, Lewin took the precaution to open the bronchi 
first and proceed towards the larynx, so that no parti- 
cles of fluid might flow from above downwards. 

Lewin, in commenting upon these results, acknowl- 
edges that experiments upon animals cannot definitely 
settle the question of the penetration of these fluids 
into the respiratory tract. There is a great difference 
between the voluntary well-directed inhalations of a 
patient, and the restless, uneasy, unnatural breathing 
of an animal being experimented upon, to say nothing 
of the effect of position of the head, tongue, epiglottis, 
soft palate, &c. He also calls attention to the fact, 
that the bronchi absorb readily, and that results may 
take place during life which cannot be demonstrated 
after death. 



OF NEBULIZED FLUIDS. 65 

Lewin's views are very similar to those of Durand- 
Fardel. 

Pathological Proofs of Penetration. 

Lewin also details {pp. cit., p. 190) a most instructive 
pathological case, in which, with Dr. Schulz, chemical 
assistant to Professor Frerichs, he found free iron in 
the interior of a cavity in the lung of a patient who, 
shortly before his death, had inhaled a solution of the 
sesquichloride of iron. This case is as follows : — 

A carriage-driver, Muller by name, get. 48, whose 
mother had died with tuberculosis, had suffered from 
dropsy as early as his seventh year, whether ensuing 
upon an attack of scarlet fever or not, could not be de- 
termined. After recovery from this illness, he asserts 
that he had remained perfectly well until shortly be- 
fore Christmas, 1861. About this time, during rather 
a cold spell, he fell asleep upon his box, and on awak- 
ening became conscious of a strong drawing pain in the 
upper thoracic region of the right side. This pain 
gradually diminished without medical interference, and 
eventually subsided entirely. Shortly before Easter 
(April 20th) the patient contracted a fresh cold, attrib- 
uted to exposure in frosty weather. Since that time 
he had been expectorating a profusion of sputa, un- 
pleasant to the taste, and producing scraping sensations 
in the throat. 

After some medicinal treatment, the amount of ex- 
pectoration became moderated during the daytime, so 
that only after night, and particularly early in the 
mornings, the patient expelled the sputa, which re- 
tained their unpleasant taste and odor, but with less 
production of the scraping. 

6* 



66 EXPERIMENTS AS TO PENETRATION 

The patient sought admittance in the Charite, and on 
May 14th, his present condition was noted down as 
follows : 

Patient rather strongly built, with moderately devel- 
oped but rigid muscles. Color of skin normal ; enlarged 
and congested bloodvessels to be seen upon the cheeks. 
Mucous membranes moderately congested. Can assume 
any position in bed, but feels too weak to remain up. 

Throat well proportioned ; its muscles slightly em- 
ployed in costo-abdominal respiration. A swollen 
lymphatic gland, rather painful upon pressure, upon 
the scalenus muscle of the right side. The voice some- 
what hoarse. No pain in the larynx. 

Thorax, in general, well formed, with a slight de- 
pression in the region of the seventh rib, right side. 
The angle of Louis marked, the clavicular furrow deep- 
ened, and more so on the right side than on the left. 
Elevation of thorax tolerably normal, no difference to 
be detected between the two sides. 

Percussion produces a tolerably high, lightly tympan- 
itic sound at the sixth rib of the right side, in the mam- 
millary line ; and so, also, in the right supra-clavicular 
fossa. Behind, upon both sides, healthy resonance 
clear beyond the attachment of the twelfth ribs. All 
over the left side, resonance clear, rather higher over 
the upper lobe than over the lower one. On the right 
side, a tolerably intense dull sound, outwards from the 
eighth spinous process. Stronger fremitus over the 
whole of the right side than upon the left side, and 
especially over the region of dulness. 

Auscultation: left and behind, vesicular murmur 
with some sonorousness and sibilance ; over the entire 
right side, very loud moist rattling and scanty rales 



OF NEBULIZED FLUIDS. 67 

masking the vesicular murmur. In front, very loud 
vesicular murmur on the left side, sharp bronchial-like 
respiration upon the right ; expiration rather long ; 
less rattling and whistling than behind. 

The patient did not cough very much during the ex- 
amination. The cough is much greater at night than 
during the daytime, and is principally induced by 
change of position. Expectoration easy, with a small 
quantity of sputum brought up by each paroxysm of 
cough. There are no long-continued paroxysms of 
cough with expulsion of large masses of sputum. The 
sputum is of a grayish-green color, distinctly translu- 
cent, only here and there a few mucous shreds extend 
from its upper mucous stratum, through a watery mid- 
dle stratum, to its tolerably homogeneous sediment. 

The impulse of the apex of the heart could not be 
felt ; the systolic heaving was diffuse. Cardiac dulness, 
normal. Sounds clear, the second sound somewhat 
flapping at the pulmonary orifice. 

The radial artery, somewhat serpentine in its course, 
of rather strong outline, weak beat, and slight tension. 

Tongue with a thick gray covering, especially in its 
central portion. 

Laryngeal mucous membrane congested, somewhat 
swollen, and covered with viscid, adherent secretion. 

Abdomen soft and rather flat ; a large scrotal hernia 
on the right side. 

Spleen and liver of normal outline. 

Appetite rather active ; thirst frequent. Alvine 
evacuations at intervals of two days. Urine cloudy, 
but without containing albumen. 

Temperature 39.5 (C), pulse 96, respiration 36. 

17th. Morning. Sleeplessness, moderate sweats, se- 



68 EXPERIMENTS AS TO PENETRATION 

vere paroxysm of cough the night previous. Ordered, 
Decoct, cinchonce (5ij) with Acid, phosphor. 

Evening. Temperature 40, pulse 104, respiration, 
28. 

18th. Morning. Temperature 38.5, pulse 96, respi- 
ration 40. 

Patient prefers to retain the semi-recumbent posture, 
but without fear of dyspnoea. Thorax rather strongly 
and actively expanded. Expression of countenance 
quiet. Quantity of expectoration some eight ounces, 
slimy, grayish-green in color, and covered with froth 
in profusion. 

19th. Morning. Temperature 38, pulse 96, respira- 
tion 44. 

Yesterday evening, after an attack of dyspnoea, 
coughed up a good deal of blood, which has afforded 
considerable relief. The sputa during the day, again 
about eight ounces, of triple consistence as before ; only 
the fluid middle portion is a brownish-red, instead of a 
grayish-green. Ify. Plumb, acet. grs. ij, dos. vj. 

20th. Blood coughed up again, but the quantity can- 
not be determined. Towards noon deep inspiration 
produces a stitch in the right side, in the region of the 
right nipple, and extending up to the axillary region. 
Percussion sound in the line of the right axilla, appears 
somewhat shorter than before. Ordered, 10 dry cups 
over the affected region. 

21st. Temperature 38, pulse 128, respiration 44. 
Has again coughed up blood to the amount of four 
ounces. The stitch in the side and the dyspnoea have 
subsided. Ordered, Plumb, acet. gr. ss., every three 
hours. 



OF NEBULIZED FLUIDS. 69 

22d. Temperature 39.4, pulse 120, respiration 44. 
Again has coughed up about four ounces of blood. 

23d. Temperature 38.5, pulse 136, respiration 60. 
Profuse sweats, great dyspnoea, intensive cough. Strong 
haemoptysis to the amount of about ten ounces. Treat- 
ment : — Inhalation from Mathieu's nepiiogexe of 
Liquor f err i sesquichlorati, at noon and towards even- 
ing, each time thirty drops in six ounces of aqua destill. 
Patient rather short-winded, and so weak that it re- 
quired great effort to make the inhalation ; still after 
the inhalation he asserted that he felt much more com- 
fortable than he had done before it. He did not cough 
as much as before by a great deal ; the dyspnoea de- 
creased; the amount of expectoration diminished in 
quantity and less sanguinolent ; the patient's counten- 
ance fresher and livelier; the speech clearer and stronger 
than before. Towards evening, temperature 32, pulse 
118, respiration 40. 

24th. Sleepless throughout the night previous, with 
severer sweat and cough. Expectoration much more 
difficult. Although respiration appeared performed in 
great part by the employment of the accessory muscles, 
there was no feeling of want of breath. The sputum 
amounted to three ounces, was translucent, the middle 
stratum dark brown, without any trace of pure blood 
discoverable in it. Death at 2 p.m. 

Autopsy, May 26th. — Marked decrease of subdermoid 
areolar tissue ; the cartilages of the ribs to a consider- 
able extent ossified. On raising up the sternum there 
was exposed to view, underneath the first rib, a cavity 
from which flowed out a black fluid with blackish shreds 
of tissue. Both lungs strongly inflated ; the left one 
totally adherent; the right one less so. From the 



70 EXPERIMENTS AS TO PENETRATION 

bronchus of the left lung there gushed forth a muddy- 
brown fluid ; the lung itself large, loose, pervious 
throughout, only in the posterior portion strongly oeclem- 
atous and hypersemic, moderately strongly pigmented. 
The bronchi very narrow, even the larger trunks. 
The muddy liquid distributed pretty fully in the lower 
lobe. Mucous membrane moderately injected. 

Upon the right side the adhesion was produced 
principally by thick fibrinous masses, under which the 
pleura appeared strongly injected. The lower por- 
tion OF THE UPPER LOBE WAS CONVERTED INTO A SAC, 
WITH THIN WALLS FIRMLY ADHERENT TO THE THORACIC 
PARIETES, IN WHICH WAS FOUND THE SHREDS AND THE 
BLACK FLUID ABOVE MENTIONED, BESIDE SOME BLACK- 
ISH-RED lumps (blood clots). The lower lobe rather 
adherent. Upon its cut surface were seen numerous 
prominent grayish-white infiltrations ; the remaining 
tissue was void of air, and on pressure allowed the escape 
of some of the muddy fluid. The middle lobe and the 
lower portion of the upper lobe showed broncho-pneu- 
monic infiltration, surrounded by oedematous tissue. 
The bronchi moderately large, and mostly filled with a 
brownish muddy-looking fluid. The vessels of the lungs 
free from adhesions, their inner walls strongly discol- 
ored. In the first rib, between the bone and the car- 
tilage, there was a small space which did not appear to 
have been made artificially. These extremities of the 
rib appeared a somewhat muddy, gray, partly carti- 
laginous and partly striated tissue. Outside of it, com- 
municating with the space, lay a small cavity, which 
was covered with reddish excrescences. The adhesions 
right at the first rib were rather strong, thick, and, in 
addition, somewhat slanting. 



OF NEBULIZED FLUIDS. 71 

In the larynx and in the trachea, but little of the 
muddy fluid. The mucous membrane discolored. 

In the heart, much fatty blood. The right cavity 
rather large in comparison with the left. Valves normal. 
The pulmonary and aortic valves somewhat glazed. 
The aorta somewhat dilated above the semilunar valves. 

On the border of the anterior sinus of Valsalva of 
the semilunar valve of the pulmonary artery, and to- 
wards the left, was discovered a small opening leading 
to a bloodvessel, which formed a small sac on the outer 
side of the aorta, and from which several branches 
coursed over the aorta ; one of the largest of these 
communicated, by a free vessel at the base of the left 
ventricle, with a small artery which arose, with a calibre 
of about a line from the aorta, close to the posterior 
coronary artery. Close to the opening of the posterior 
coronary artery there was a still smaller aperture, from 
out of which air could be fo*rced by blowing into the 
network of vessels described as originating from the 
pulmonary artery. At the commencement of the aorta 
there were a great many adhesions, chiefly rounded 
superficially. 

The black-colored liquid found in the protected 
cavity in the lower portion of the upper lobe 

WAS EXAMINED BY THE CHEMICAL ASSISTANT, Dr. 
SCHULZ, IMMEDIATELY AFTER THE AUTOPSY, AND 
SHOWED THE PRESENCE OF FREE IRON, AS ALSO DID THE 
BLACKISH CLOTS — OF COURSE BUT IN SMALL PROPOR- 
TION. Here we have the strongest possible evidence 
of the penetration into the lung of inhaled nebulized 
fluids. 

In a somewhat similar case related by Prof. Zdek- 
auer, of St. Petersburg ( Wiener Med. Wochenschrift, 



72 EXPERIMENTS AS TO PENETRATION 

No. 30, 1861 ; Fieber, op. cit., p. 42 ; and Lewin, op. 
cit., p. 240; et al.), a patient died from debility shortly 
after the restraint of a profuse haemoptysis by inhala- 
tions of a strong solution of the chloride of iron. Dr. 
Holm discovered everywhere in the tissue of the lung 
iron in greater quantity than could be due to the blood. 
As Fieber mentions in a foot-note, this case proves the 
penetration of the fluid into the minutest ramification 
of the bronchi. 

Waldenburg (op. cit., pp. 111-165) instituted a 
great number of ingenious experiments upon men and 
animals, not so much to prove the entrance of the ma- 
terial into the respiratory tract, of which ability he had 
no doubt, as to determine the quantity or proportion 
that thus penetrated, and also in w T hat form they reached 
the parts, whether still as spray or condensed into 
drops ; but, for reasons that are obvious, he was unable 
to come to any satisfactofy conclusion. 

Prof. Gerhardt, of Jena (Inhalation medikamen- 
toser Flilssigkeiten. Fin Beitrag zur Localtherapie 
respiratorischer Erhranhungen. Von Rudolf Wede- 
mann, Jena, 1862 ; quoted by Fieber, op. cit., p. 49), 
repeated a number of experiments upon men. He 
caused several invalids to inhale a chloride of iron solu- 
tion, and shortly after, by the aid of the laryngoscope, 
he pencilled the larynx with a solution of tannin. The 
laryngeal image showed the inky reaction on the apices 
of the arytenoid cartilages, and on the posterior surface 
of the epiglottis ; in one case, several dark spots could 
be seen upon the true vocal cords. In one patient, with 
a fistule between the hyoid bone and the thyroid car- 
tilage, a paper which had been dipped into a solution of 
tannin was held in the fistule after a few inhalations of 



OF NEBULIZED FLUIDS. 73 

a solution of the chloride of iron had been taken, and 
the usual reaction of these salts ensued. 

Wedemann (op. cit., pp. 30-43) records many clin- 
ical observations confirmative of the question discussed. 

Semeleder (Wochenblatt der Zeitschrift d. k. k. 
Gfesellsch. der Aertzte in Wien, 1864, No. 1, quoted by 
Fieber, op. cit., p. 51) found that after the inhalation 
of astringent solutions, the secretions collected at sev- 
eral places in the larynx as whitish floccules, with a re- 
duction of the capillary injection attendant on inflam- 
mation of the true and false vocal cords. 

Prof. Niemeyer, in the latest (6th) edition of his 
Manual of Special Pathology and Therapeutics (1865), 
states that the fact of the entrance of these sprays ad- 
mits of no doubt. He had treated with markedly satis- 
factory results, chronic laryngeal catarrh, follicular 
laryngitis, and pharyngitis, &c, employing solutions of 
alum, tannin, and nitrate of silver. 

Dr. Morell Mackenzie, of London (Med. Times 
and Grazette, 1865, No. 765, p. 213), stated at a meet- 
ing of the Royal Medical and Chirurgical Society, of 
London, Feb. 14th, 1865, that, in conjunction with 
Dr. Duchesne, of Woodford, he had performed some 
experiments upon pigs and dogs, and with positive re- 
sults ; and Dr. Gibb expressed his conviction, based 
upon his own observations, that the fluids penetrated 
into the minutest bronchi. 

Besides the experiments above detailed, many others 
were instituted by different observers in various parts 
of Germany, in Russia, Spain, Great Britain, &c, but 
the results do not differ from those already recorded. 
The entrance of the nebula, upon voluntary inspira- 
tion, into the larynx, can easily be demonstrated by 

7 






74 



causing an individual to inhale a colored solution, as of 
indigo, aniline, &c, under circumstances favorable for 
penetration, and then examining the parts by aid of the 
laryngoscope. 

In these experiments it is desirable to secure as finely 
divided a nebula as possible, and its delicacy can be 
tested by using a colored solution, as of indigo, and 
allowing the spray to strike against a piece of unglazed 
paper, which will become more or less completely cov- 
ered, showing the degree of tenuity of the drops; a plan 
first employed by Siegle, who binds up in his work a 
page on which is pasted two strips of paper thus sub- 
jected to two apparatuses, his own having produced a 
spray so fine that the paper looks as if it had been 
dipped in the solution, so evenly is it colored. Another 
method of testing the degree of subdivision, and which 
is applicable to any solution, is to allow the nebula, as 
it is produced, to strike against a pane of window glass, 
and notice the minuteness of the condensing particles. 

Thus, in despite of the experiments with negative re- 
sults, we are led to the conclusion that nebulized fluids 
can be inhaled deeply into the respiratory tract ; and 
that when failure occurs it is due to unfavorable posi- 
tion of the glottis, or an improper method of inhalation. 



CHAPTER III. 

the inhalation of nebulized fluids ; the propor- 
tion of nebula inhaled ; immediate effects of 
inhalation; manner of conducting inhalations; 
the number, strength, and duration of inha- 
lations, etc. 

From what has already been narrated it is evident 
that the inhalation of nebulized fluids can be utilized 
for the alleviation and cure of disease, and that the 
method at once enlarges our resources in local treat- 
ment ; presents us with a means of affecting the sys- 
tem by absorption without compromising the digest- 
ive powers of the alimentary canal, or interfering with 
them ; for the mucous membrane of the air-passages is 
much quicker to absorb than that of the stomach, be- 
sides which, the attenuated form in which the remedy is 
presented secures a subdivision of labor, as it were, on 
the part of the absorbent vessels, so that an effect more 
prompt and sustained may be produced, than w r hen the 
remedy is presented in bulk and thus subjected to 
gradual ingestion ; while the absence of a digestive 
process secures the absorption of the remedy in the 
chemical form in which it is exhibited. 

It will be seen that the powers of absorption of the 
pulmonary mucous membrane have been employed for 
systemic medication, where idiosyncrasy or disease has 



76 THE INHALATION OF NEBULIZED FLUIDS. 

prevented the administration of remedies in the usual 
way. 

How much of the Spray reaches the Larynx, Trachea, 
and Lungs ? 

This is a question that every skeptic puts, and it is a 
difficult one to answer. 

Beigel reports the following results obtained by him 
with Siegle's apparatus : 

"If the boiler, which contains about eight ounces, is 
half filled, viz., with four ounces of water, and the lamp 
beneath lighted, the evolution of steam begins in about 
ten minutes. One ounce of fluid is then, between 
twenty-five to thirty minutes, turned into spray and in- 
haled. The quantity of condensed fluid, after the in- 
halation obtained through the tube of my screen, is 
about four drachms, the loss in the boiler one ounce. 
Half an ounce of medicated spray was, therefore, 
mixed with one ounce of steam. About half of that 
quantity recoils from the screen into the air, while 
the other half reaches the mouth. Here, again, about 
half the quantity remains, to be either swallowed or 
spit away, whilst the other half, viz., about three drachms 
of mixture of steam and medicated fluid passes the glot- 
tis and penetrates into the respiratory tract. In re- 
spect to that mixture, the conclusion may fairly be 
drawn that it contains a far greater quantity of atom- 
ized fluid than vapor. Not only because it can be as- 
sumed, a priori, that the heavier particles of the fluid 
are driven by the force of the blast into the mouth, 
whilst the lighter steam mixes very readily with the 
atmosphere, but because an analysis of the fluid, ob- 
tained by condensation, shows that the original strength 



THE PROPORTION OF NEBULA INHALED. 77 

of the solution is diminished but little ; at least, it was 
so in solutions of common salt, which I have tested. 
The experiment, to show that the steam dissolves into 
the air, while the atomized clouds rush forth, can easily 
be made with my screen. The opening through which 
the patient inhales is closed, the apparatus put into ac- 
tion, and the condensed fluid gathered. If steam merely 
escapes, we find that after one ounce of water has been 
turned into steam, about twenty minims only have been 
condensed and gathered in the vessel, while it contains 
about six drachms, when atomization has taken place at 
the same time. The conclusion is, therefore, obvious, 
that the strength of the medicated fluid is altered but 
very little through its mixture with the steam." (Beigel, 
pp. 49, 50, 51.) 

The probabilities are, that from one-sixth to one- 
twelfth of the fluid nebulized reaches the respiratory 
tract ; but we must allow for the absorption by the 
buccal mucous membranes of much that reaches the 
mouth and is there condensed ; and as the proportion 
differs much according to the manner of inhaling, the 
doses to be employed will vary according to the propor- 
tion apparently actually inhaled in any given case ; in 
determining which, the physician will have to depend 
upon his own judgment after witnessing his patient's 
manner of inhaling. 

Dr. James Collins, of this city, has furnished me 
with the following result of some experiments instituted 
by him to ascertain the probable amount of nebula re- 
ceived into the system. 



78 



THE INHALATION OF NEBULIZED FLUIDS. 



A steam apparatus was used with the Bergson tubes. 
The amount of drippings collected were carefully evap- 
orated, and the residue weighed : 



Ferro-ferricyanide of potassium, g 
were dissolved in 2 ounces 
Eesidue from drippings, 

Loss, .... 


rammes 2 
of water 


grammes 1.445 
.555 


Sulphate of copper. 

Residue in drippings, 


grammes 2 

1.181 


Loss, .... 


.819 


Bicarbonate of potassa, . 

Residue from drippings, 


grammes 2 

1.545 


Loss, .... 


.455 


Nitrate of potassa, 

Residue from drippings, 


grammes 2 

1.285 


Loss, .... 


.715 


Muriate of ammonia, 

Residue in drippings, 

Loss, 


grammes 2 

1.845 

.155 



An analysis of the residue of fluid, containing chlor- 
ate of potassa 20 grains to the ounce, and deposited on 
the sides of a mouth speculum which had been used in 
inhaling, resulted as follows : 

On speculum, ..... grammes .058 

Residue of 4 ounces of fluid, . . 2.755 

Total residue, 2.813 

Original contents, 80 grains, . . grammes 5.183 

Loss, 2.370 



IMMEDIATE EFFECTS OF INHALATION. 79 

Immediate Effects of the Inhalation of Nebulized 
Fluids. 

If the nebula really penetrates beyond the glottis, a 
peculiar sensation will immediately be felt in the tra- 
chea and upper sternal part of the chest, according to 
the depth of the inhalation and the amount of permea- 
tion by the fluid. As facility of inhalation is acquired, 
this feeling will be produced over a greater extent of 
surface. If the fluid nebulized be at the ordinary tem- 
perature, a sense of cold will be felt in the parts; and 
if ice-water be inhaled the sense of cold will be very 
distinct. Sometimes a sense of oppression, and occa- 
sionally of real soreness, is experienced, especially when 
at a first attempt at inhalation, a strong solution as of 
an astringent or caustic is employed ; hence it will be 
found desirable as a rule to cause a patient to inhale 
some bland fluid at his first attempt until he becomes 
accustomed to the method, unless it be a case of haem- 
optysis, when it is better to proceed at once with the 
astringent. Haemoptysis has occasionally been induced 
by inhalation, having, as will "be seen in the following 
pages, occurred under the observation of Fieber. Dr. 
Da Costa [Essay on Inhalation, p. 20) states that on 
two occasions he has seen from the inhalation of a strong 
solution of alum, asthmatic, wheezing breathing very 
speedily produced, with loud dry raies discernible at 
various parts of the chest; the attack lasting from eight 
to ten minutes. Dr. Collins tells me that he has wit- 
nessed the same effect. 

If discomfort arise during an inhalation, the proce.ss 
should be suspended, and the parts gradually accus- 
tomed to the procedure ; and if the effect should follow 
invariably, the method should be discontinued. 



80 THE INHALATION OF NEBULIZED FLUIDS. 

Usually, the sensation is not disagreeable ; the first 
few inhalations induce titillation of the glottis provoca- 
tive of cough ; but this soon ceases, and at subsequent 
inhalations cough is not produced ; and, indeed, in some 
instances, the inhalation does not produce any cough. 
As a general rule, there is cough at the conclusion of 
each inhalation, or shortly after it, with freedom and 
increased facility of expectoration. 

If there is inflammation of the upper air-passages 
with pain and soreness, the inhalation almost invaria- 
bly affords an immediate feeling of relief, probably by 
supplying moisture to the parts, and of course as a 
topical effect also of the narcotic or sedative which 
may be employed. 

Manner of Conducting the Inhalation of Nebulized 
Fluids. 

The patient should sit at ease in front of the appa- 
ratus, tlje distributing tube from which should be on a 
level with his mouth. Siegle recommends that the pa- 
tient lean the chest forward with the elbows or arms 
resting upon the edge of a table. This position will, 
I think, be found the most suitable and convenient, un- 
less in exceptional cases. Waldenburg recommends 
that the patients should, when strong enough, stand up 
and take their inhalations; but this position does not 
permit of as free an expansion of the chest, and calls 
off part of the muscular force of the auxiliary muscles 
of respiration for the maintenance of the erect posture, 
and, necessitating frequent respiration, the inspirations 
are, of course, less deep. Lewin prefers that the back 
should be supported, instead of permitting the patients 
to lean forward. 



MANNER OF CONDUCTING INHALATIONS. 81 

As soon as the apparatus is in action, which, with the 
steam apparatus, will usually be in from three to five 
minutes after the application of the flame, — and sooner 
if the precaution be taken to pour hot water into the 
boiler, thereby saving time and alcohol, — the patient 
should be directed to incline his head a little backwards, 
thus bringing the oral and laryngeal cavities more to- 
wards a direct line, and the spray, with or without the 
intervention of a funnel or face protector, allowed to 
pass into the mouth of the patient, who should make 
deep and regular inspirations and expirations. 

It is impossible to give precise rules as to the distance 
from the apparatus at which the patient's mouth should 
be maintained, or the time that shall be occupied in each 
inhalation. Differences suitable to each case, dependent 
on irritability of structures, facility of inhalation, &c, 
will occur with every individual. Usually a rather 
warm spray is more pleasantly endured at a first inha- 
lation, and therefore it is well at the beginning of each 
inhalation to place the delivery tube at a distance of but 
from four to six inches from the mouth of the patient, 
and then gradually increase the distance to from twelve 
to twenty-four inches, as may be most suitable. If the 
laryngeal structures are very irritable, the first sitting 
should not occupy more than five minutes, and the in- 
halation should not be repeated the same day. As the 
parts become accustomed to the irritation, and the fa- 
cility of inhalation increases, the time of each inhala- 
tion may be increased to ten or fifteen minutes, and be 
repeated from two to ten times a day, according to the 
indications. 

It will be found a better plan to designate a certain 
quantity to be inhaled as a dose, and gradually increase 



82 THE INHALATION OF NEBULIZED FLUIDS. 

the amount, than to prescribe a certain number of in- 
halatory efforts, or a certain duration of time; as regard 
to either of these particulars distracts the attention of 
the patient. 

The temperature of the spray lessens with the in- 
crease of its distance from the apparatus, and the force 
of the current is also affected in like manner but in a 
less degree, this depending rather upon the rapidity 
with which the steam is formed and heat regulated by 
controlling the size of the flame with the screw attached 
to the wick. 

The following are the rules laid down by Siegle to be 
observed with his apparatus, having the thermo-barom- 
eter to designate the steam pressure. 



•{ 



•{ 



Stream strong. Temperature high. 

Thermo-barometer 2°. Distance 2-6 inches. 

e.g., In Laryngitis Crouposa. 

Stream strong. Temperature low. 

Thermo-barometer 2°. Distance 1-2 feet. 

e.g., In Pharyngitis Chronica. 

Stream weak. Temperature high. 

Thermo-barometer 1°. Distance 2-6 inches. 

e.g., In Tuberculosis of Lungs and Larynx. 



i ( Stream weak. Temperature low. 

t Thermo-barometer 1°. Distance 1-2 feet. 

e.g., In Hemoptysis. 

In the apparatus of Sales-Girons and others working 
by pressure, the temperature can be increased by placing 
a flame behind the drum ; the current of the nebula 
creates a vacuum directly behind the point on which 
the spray strikes, and this draws the flame inwards and 
heats the spray. 

It is difficult to lay down special rules which shall be 



MANNER OF CONDUCTING INHALATIONS. 83 

applicable to every case, and every physician employ- 
ing this method will soon learn by practice to regulate 
the manner of inhalation so as to suit his cases. Prac- 
tice soon enables the patients to inhale properly, and 
also to overcome the disposition to cough, which is some- 
times very great in their earlier efforts. Where diffi- 
culty is anticipated, or where patients manifest consider- 
able concern, it will be best at first that they should 
merely be allowed to inhale the steam issuing from the 
apparatus, or plain water, and then the medicated fluid 
can be added gradually. For the same reason the pres- 
sure of the steam at the commencement of a sitting 
may be moderated, gradually rising to a higher degree 
of the therm o-barometer by increasing the size of the 
flame. 

Where the patients are more intelligent, but at the 
same time nervous, a somewhat similar management 
may become necessary. Such patients can sit at first 
a little sideways, so that the current streams past 
the face ; then, as they become accustomed to it, they 
can bend forward from time to time so as to get the 
open mouth in the passing current, and then take in a 
deep breath of the spray from the side. 

With small children and bed-ridden patients, the ap- 
paratus can very readily be so placed that the current 
can be directed into the mouth of the patient while lying 
upon his side. The pillows and adjacent bed coverings 
must be covered with some suitable material before the 
inhalation is begun, in order to protect the bed from 
moisture. 

Larger children are most conveniently managed by 
taking them upon the lap in order to remove their 
anxiety, and showing them the movements of inhala- 



84 THE INHALATION OF NEBULIZED FLUIDS. 

tion. In this manner children of three years of age 
soon learn to inhale with real enjoyment or childish de- 
light in the process. 

Moura-Bourrouillou recommends holding the nostrils 
closed by means of the finger or some special contriv- 
ance, in order the better to secure penetration of the 
spray into the air-passages. Traube recommends that 
the patient should extend the tongue well out of the 
mouth. Siegle holds both of these directions unneces- 
sary ; on the contrary, if the tongue is very fleshy and 
seems to be much in the way, lessening the oral orifice, 
he directs the patient to keep it depressed himself with 
a knee-shaped spatula. The mouth speculum subserves 
the purpose of a tongue-depressor. 

The physician must by no means neglect to watch 
the first inhalations of his patient ; otherwise, after a few 
moments, the tongue will be allowed to raise so that its 
base will press back upon the soft palate instead of 
being flatly applied to the floor of the mouth, with the 
tip behind the lower incisor teeth ; or the head will 
have assumed an unfavorable position, the mouth be no 
longer properly opened, the inspirations become less 
energetic, or too frequent, &c. &c. 

Siegle also recommends that, in the beginning, the 
patient take an inspiration as if he were going to gape, 
or inspire after a quiet prolonged articulation of the 
diphthong sound ce. 

At the close of the inhalation, the patient should 
cleanse the mouth and pharynx by gargling with fresh 
water. If, however, the inhalation has been taken for 
an affection of the mouth or pharynx, this gargling can 
be dispensed with, that the medication may secure a 
longer local effect. 



MANNER OF CONDUCTING INHALATIONS. 85 

In concluding, Siegle cannot call too much the atten- 
tion of physician and patient to the following rules : 

1st. Take care that the temperature of the spray and 
the strength of its propulsion remain constant during 
the entire continuance of the sitting. This has ref- 
erence to the patient's distance from the instrument, 
as well as the pressure as indicated by the thermo- 
barometer. 

2d. Never permit an inhalation to be taken after 
bodily exercise or mental excitement, so long as the 
temperature of the skin remains elevated, or the pulse 
or respiration disturbed. 

3d. Several hours must elapse between a hearty meal 
and the inhalation. 

4th. In affections of the phalanx the respiratory 
efforts of the patient need not exceed those of his ordi- 
nary breathing. In affections of the larynx, the wind- 
pipe, the bronchi, and the lungs, the force of the inspi- 
ration must be greater in proportion to the distance of 
the affected structures from the mouth ; the deepest in- 
spirations being necessary in affections of the lungs. 

5th. Let the patient rest awhile from time to time 
during the inhalation; and under no circumstances must 
the length of a sitting exceed a period not justified by 
the strength of the patient. 

6th. The excess of spray condensing in the mouth 
and accumulating, especially when not composed of 
harmless substances, such as mere water, common salt, 
&c, must be expectorated into some conveniently placed 
receptacle. 

7th. Children and infants should not be out of view 
for a single moment during the inhalation. 

8th. After the inhalation let the patient, who will 



86 THE INHALATION OF NEBULIZED FLUIDS. 

then begin to cough more than usual, remain quiet for 
a quarter of an hour before he leaves the apartment. 

9th. During the inhalation the patient should not be 
allowed to speak, nor should any conversation be held 
with him. His entire attention should be directed upon 
the inhalation. 

Before proceeding with a medicinal solution it is 
often well, especially with nervous patients, to begin 
with pure water, and gradually add the medicated solu- 
tion drop by drop. In some cases, where even water 
could not be inhaled, Beigel has found advantage from 
employing milk, after the inhalation of which for some 
time, he has been able to proceed with the desired 
remedy. 

With some children Hauk succeeded by forming his 
solution into an emulsion, so that it was mistaken for 
milk, and thus inhaled more readily than if the subter- 
fuge had not been resorted to. 

Number, Strength, and Duration of Inhalations, $c. 

The time which shall be devoted to taking an inhala- 
tion will depend upon the quantity of the medicament 
which is desired to be introduced at each sitting, and 
upon the special apparatus employed, the minuteness 
of the particles of the spray, and considerations of a 
similar character. The glass apparatus of Lewin has 
been so constructed as to nebulize two ounces of fluid 
in one minute by from forty-eight to fifty-two strokes 
of the pump ; and as he has found the most convenient 
quantity for each inhalation to be forty-eight ounces, 
it will require twenty-four minutes to reduce this 
amount into spray. This will be found rather a tire- 



MANNER OF CONDUCTING INHALATIONS. 87 

some sitting for most patients, and also very wasteful 
of the fluid, for his own experiments show that of the 
forty-eight ounces nebulized, but three ounces find 
entrance into the mouth of the patient ; and therefore 
the strength of the solution must be so graduated as to 
contain in three ounces as much of the substance dis- 
solved as is desired to be brought in contact with the 
mucous membrane of the pharynx, larynx, bronchi, &c. 

With the apparatus of Bergson, eight ounces are 
required to be nebulized to introduce three ounces of 
spray into the mouth, which will take from twelve to 
fourteen minutes, and require about forty-eight com- 
pressions of the bellows or bag. With Mathieu's ndph- 
ogene six ounces are required, consuming from ten to 
twelve minutes. With Lewin's steam hydrokomion, 
four ounces, and twenty minutes. It is difficult to say 
how much of this goes beyond the larynx or into it. 
With most of the steam apparatuses it takes from ten 
.to fifteen minutes to nebulize an ounce — the usual 
amount employed for one inhalation ; but by increasing 
the force of the steam, and enlarging the size of the cap- 
illary openings of the tube, it can be accomplished in 
from four to seven minutes. 

For acute diseases, usually three and four inhalations 
daily will be sufficient. More frequent inhalation will 
be requisite in croup and diphtheria. In chronic affec- 
tions one or two a day will suffice. 



CHAPTER IV. 

ARTICLES OF THE MATERIA MEDICA SUITABLE FOR 
NEBULIZATION. 

Any article of the materia medica soluble in water 
or in weak alcohol, is suitable for submission to the 
method of nebulization. Oils, and solutions in glycer- 
ine, have also been employed ; but a fine spray cannot 
be produced with them, inasmuch as the aperture from 
which the fluid escapes must be larger than for watery 
and spirituous solutions ; though for applications ante- 
rior to the larynx they are much better adapted than 
ordinary pencillings or garglings, because, by the minute 
subdivision of particles, more complete contact is se- 
cured, as well as a more continuous effect. 

The sulphurous waters are decomposed by this pro- 
cess, giving off their hydrosulphuric acid ; but the ex- 
temporaneous solutions usually employed are not thus 
altered. 

The materials employed should be chemically pure, 
and the solutions well filtered before using, in order 
that no sediment may accumulate to clog up the aper- 
ture through which the fine stream of fluid is forced. 

Simple pharmacy is more necessary to be observed 
here, than in the administration of remedies by the 
stomach ; and it is best always to begin with as weak 
a solution as will suit the case, the substance employed 



ARTICLES OF THE MATERIA MEDICA, ETC. 89 

to be selected with reference to a physiological and 
therapeutical influence upon the constitution, as well 
as for its local effect. 

The absorptive power of the mucous membrane of 
the respiratory organs being much greater than that of 
the stomach, poisonous substances must be employed 
with great caution, and the doses be augmented very 
gradually. 

The strength of any solution to be employed will 
depend upon the individuality of the patient, his dis- 
tance from the instrument, the length of the sitting, 
and similar considerations. 

List of Medicines hitherto Nebulized for Inhalation; 
with the Doses, §c. 

The following list comprises, to the best of the writer's 
knowledge, all the principal remedies hitherto used for 
purposes of inhalation by the process of nebulization, 
with the doses in which they have been employed, the 
diseases for which they are recommended, and, as far 
as could be ascertained, the authorities by whom they 
were first introduced : 

1. Water. 

a. Cold "Water. — First recommended by Fieber in haemop- 
tysis, at a temperature of 8°-10° R. 

A very grateful application to the burning heat of certain 
pharyngeal affections. 

b. Warm Water. — Extensively employed to promote secre- 
tion, to dilute mucus and facilitate its detachment from the mucous 
membrane of the air-passages. Valuable in laryngeal angina and 
laryngeal croup (Siegle). Applicable to local relief in diphtheria. 
A grateful application in all forms of inflammation of the pharyn- 
geal and laryngeal and tracheal mucous membranes. Promotes 
expectoration in croup by supplying watery material and retard- 
ing evaporation in the formation of false membrane. Useful to 

8* 



90 ARTICLES OF THE MATERIA MEDICA 



relieve the pain of ulcerative processes and keep the parts cleansed. 
Used in asthma and bronchitis. » 

2. Potass^: Peemangams. 

Used by Reveil {Arch. Gen. de Med.) as a disinfectant to purify 
the atmosphere, nebulizing in the room a solution containing one 
large teaspoonful to two and three-quarters pounds of water. Also 
20-30 drops per day in pharyngeal diphtheria. 

I have found it valuable as a detergent and astringent in ulcer- 
ative tonsillitis and other suppurative affections of the throat. 

3. Liquor Ferri Sesquichloratis. 

Dose: 5-30 drops to the ounce of distilled water. In much 
stronger solution as a styptic in chronic pharyngitis and chronic 
laryngitis. 

Diseases. — In haemoptysis (Hillairet, Zdekauer, Lingen, Lewin, 
Waldenburg, Siegle, Wedemann, Leiblinger, Fieber, $c.) ; to repel 
excessive secretions from the air-passages ; in pulmonary catarrh ; 
in atonic affections of the respiratory organs. In whooping-cough 
(Siegle). In the earlier stages of phthisis, and as a weak inhala- 
tion in hysterical aphonia (Da Costa). In diphtheria (Lewin). 

According to Lewin, contraindicated in phthisis of delicate 
females, accompanied with fever and irritability of the mucous 
membrane. 

Care must be taken that the teeth are not blackened by this 
solution, and it is therefore desirable to pass a mouth speculum 
some distance beyond the teeth to protect them. 

Unless prepared at the moment required, the solution should 
be kept in a dark place, to prevent precipitation of the salt. 

Accumulations of sediment upon the glass tubes are best re- 
moved by baths of sulphuric acid. 

4. Ferri Subsulphas (MonseVs Salt). 

Dose : Grs. J-10 to the ounce of water. 
Diseases. — Same as other salts of iron. 

5. Alumen. 

Dose: 5-30 grains to the ounce of water, or some aromatic in- 
fusion. 

Diseases. — Inflammation, especially catarrhal, of the pharynx 
and upper air-passages. Excessive secretion (Niemeyer). In 



SUITABLE FOR NEBULIZATION. 91 

haemoptysis (Tobold, Polansky, Schlesinger, Siegle), where it seems 
to produce a more prolonged effect than the chloride of iron. Diph- 
theritis (Lewin). Laryngeal excrescences (Siegle). In combina- 
tion with tar-water in phthisis (Waldenbitrg). 

In a coarse spray, an excellent substitute for the gargle in in- 
flammatory conditions of fauces, tonsils, &c. With the duck-bill 
tubes, and Clarke's bellows, it can be accurately applied. 

In acute tonsillitis, and acute inflammations of the adjacent 
structures generally. 

6. Acidum Tannicum. 

Dose: 1-20 grains to the ounce of water. 

Diseases. — The same as alum ; but seems more applicable than 
alum where the affections have attained some chronicity. Diph- 
theria, pulmonary gangrene (Trousseau). Croup of the larynx 
(Barthez, Lewin, Fieber). (Edema of the glottis (Trousseau). 
Chronic catarrhs ; chronic affections of fauces, pharynx, larynx, 
&c. Hypersecretion. Haemoptysis : ^j — 3 SS - to Aq. fl. fjj (Po- 
lansky, Fieber). Polypoid excrescences (Fieber, Siegle). Paraly- 
sis of vocal muscles (Klimbacher). As an antiseptic. 

Begin ordinarily with small doses, and desist if it produce too 
much dryness or sensation of heat. 

7. EXTRACTUM RhATANIjE. 

Employed by Bataille in chronic inflammation of the mucous 
membranes of the air-passages. 

8. Argenti Nitras. 

Dose: ^-10 grains to the ounce of water. 

Diseases. — Granular pharyngitis (Lewin, Waldeman). Inflam- 
mations and ulcerations of pharynx and larynx. Moist growths. 
Dipththeritis (Lewin). Chronic laryngeal and pharyngeal catarrhs 
(Niemeyer). 

Care must be taken that too deep inspirations are not taken 
when employed for affections of the upper passages. 

The mouth speculum, a face protector, or a mask, should be 
used to prevent discoloration of the face. 

The solution should be kept in the dark, and refiftered before 
being used. 

9. Aluminium Nitricum. 

Dose : Grains 2-5 to the ounce of water. 



92 ARTICLES OF THE MATERIA MEDICA 

First used by Beigel, who prepares it from a simple solution of 
the metal in nitric acid ; agitating the crystals in distilled water 
repeatedly, condensing the solution by evaporation, and recrystal- 
lizing. Eendered great service, not only in inflammation, but 
also in nervous affections of the larynx and trachea. 

10. Sodii Chloridum. 

Dose: Grains 1-drachms 4, to the ounce of water. 

Useful in catarrhs of the air-passages. 

Waldenburg uses it in doses of 1-10 grains to the ounce, and at- 
tributes to it all the good effects produced by the inhalation of the 
various mineral waters. 

Beigel sets the apparatus in different parts of the room so as to 
get up a sort of artificial sea air in the atmosphere for a time ; and 
he recommends it as giving great relief in all stages of consump- 
tion. 

Lewin employs it in small doses to relieve cough and promote 
expectoration. 

Liebig recommends it in combination with tannin in chronic 
catarrhs with difficult expectoration. 

11. Liquor Sode Chlorinate. 

Dose: f^ss-f^j. 

Diseases. — In bronchitis with offensive and copious expectora- 
tion. In phthisis. As a disinfectant to purify the atmosphere. 

12. Potass^e Chloras. 
Dose : Grains i-xx to the ounce of water. 

Diseases. — Diphtheria (Fieber, Lewin). Aphthse of children 
(Siegle). Pharyngitis {Lewin). 

13. POTASSII IODIDUM. 

Dose: Grains ij-xx to the ounce of water. 

Diseases. — Granular inflammations of larynx and pharynx. 
Induration and chronic thickenings of laryngeal structures 
(Lewin). In glandular complications. Chronic bronchitis with 
emphysema? 

14. Potassii Bromidum. 

Dose: Grain i-x to the ounce of water. 
Diseases. — Laryngeal croup (Schnitzler). 



SUITABLE FOR NEBULIZATION. 93 



15. TlNCTURA IODINII. 

Dose: Gtt. j-xx to the ounce of water. 

Diseases. — Follicular inflammations of larynx and pharynx. 
Pharyngitis sicca. All affections of the throat where there has 
been implication of the glandular structures. Granular pharyn- 
gitis (Siegle). 

16. Ammonia Murias. 

Dose: Grains ij-£ij to the ounce of water. 

Diseases. — Kecent laryngeal and bronchial catarrh, where it 
promotes expectoration (Lewin). Emphysema ; catarrh ; simple 
bronchitis (Gerhardt, of Jena). In combination with salt, in 
phthisis (Gerhardt, of Jena). Pneumonia, croup, chronic bron- 
chitis, chronic pneumonia. In early forming stage of bronchitis. 

17. Potass^e Carbonas. 

Dose : Grains x-3ij to the ounce of water. 

Diseases. — Same as muriate of ammonia, especially in certain 
forms of follicular pharyngitis (Siegle). Follicular pharyngeal 
catarrh {Lewin). Substitute for a gargle; also, for a very dilute 
solution of caustic potassa. Pseudo-membranous croup ; whoop- 
ing cough ; pneumonia. 

18. Plumbi Acetas. 

Dose : Grains iij-x to the ounce of water. 

Diseases. — In obstinate, troublesome colds, not yielding to other 
medicament (Beigel). Also, by Waldenburg. In acute catarrhs 
of larynx and bronchi (Fieber). 

19. Zinci Sulphas. 

Dose: Grains v-xx to the ounce of water. 

Diseases. — As a gargle in chronic inflammations. In excessive 
secretions (Siegle, Fieber, Lieblinger). 

20. Cupri Sulphas. 

Dose : Grains j-xx to the ounce of water. 

Diseases. — Chronic inflammations. Pharyngitis and laryngitis 
(Vogler). Ulcerative tonsillitis. Ulcerations of fauces and phar- 
ynx. Pulmonary gangrene (Trousseau). 



94 ARTICLES OF THE MATERIA MEDICA 



21. Liquor Potass^: Arsenitis. 

Dose: G-tt. j-xx to the ounce of water. 

Diseases. — Nervous asthma (Trousseau, Wistinghausen, Lewiri) 

22. Sod^] Chloras. 
Disease. — Asthma. 

23. Liquor, Iodinii Compositus. 

Dose: Gtt. ij-xv. 

Disease. — Chronic bronchitis [Da Costa). 

Pot. iod. ^j-gss. ; iodinii pur. grs. j-ij ; aqu. dest. ft)ij. In syph- 
ilitic laryngitis ( Waldenburg). 

24. Argentum Iodidum. 

Used by Gibb in phthisis in the second stage with profuse ex- 
pectoration, and with laryngeal affections at the same time. 

25. Hydrargyri Bichloridum. 

Dose: Gr. ss.-ij to the ounce of water. 

Diseases. — Syphilitic affections of pharynx and larynx (Lewin, 
Schnitzler, Waldenburg, Demarquay, $c). In syphilitic excres- 
cences (Siegle). The inspirations must not be too deep. 

26. Aqua Picis Liquids. 

Dose : f^j-ij of officinal solution. 

Diseases. — Putrid bronchorrhoea without fever (Lewin, Walden- 
burg). Colliquative sweats, and purulent secretion of phthisis 
(Lewin). Pulmonary gangrene. Dilated bronchi with emphy- 
sema ( Waldenburg). Vesicular emphysema. 

Siegle calls it an antiseptic, par excellence. 

27. Aqua Calcis. 

Dose : 1 part lime to 100 of water. 

Diseases. — Diphtheria ; pseudo-membranous croup (Biermer). 

28 Aqua AssAFCETiDiE. 

Used, by Lewin, in asthma with emphysema, in combination 
with aq. menth. pip. and aq. castorei. 



SUITABLE FOR NEBULIZATION. 95 



29. Aqua Amtgdalaej; Amar^;. 

A good menstruum for chloride of iron and other irritant arti- 
cles (Lewiri). A sedative in painful affections of the larynx and 
upper air-passages. Excessive paroxysmal cough (Siec/le). 

30. Tinctura Opii Simplex. 

Dose : Gtt. v-xx to the ounce of water. 

Diseases. — Suitable to troublesome coughs in any affection where 
opium is not contraindicated. Suitable to painful inflammations, 
as in angina tonsillaris, &c. As an addition to other solutions. 

31. Extractum Opii. 

Dose: Gr. j-v to the ounce of water. 

In this largest dose I have used it to avert a severe tonsillitis, 
producing all the physiological effects of the drug much more 
promptly than by ordinary administration. 

In doses of gr. \ to gr. £, Dr. Da Costa uses it in irritative 
'coughs, and as an adjunct to allay irritation. 

32. MoRPHI/E ACETAS. 

Dose : jL— | gr. to the ounce of water. 
Diseases.-^S&me as preparations of opium. 

33. Extractum Hyoscyami Alcoholicum. 
Dose: Gr. ^-2 to the ounce of water ; of fluid extract, gtt. iii-x. 
Diseases. — Spasmodic coughs. "Whooping cough, intense bron- 
chitis, bronchial catarrh with spasm [Fieber). Phthisis (Leiblinger, 
Lewin). 

34. Extractum Cannabis Indicum. 
Dose : Gr. \-\ to the ounce of water. 
Diseases. — Spasmodic cough of phthisis (Leiblinger). 

35. Tinctura Cannabis Indica. 
Dose : Gtt. v-x to the ounce of water. 
Diseases. — Spasmodic coughs. Irritative coughs. 

36. Extractum Conii. 
Dose: Gr. j-vj to ounce of water; of fluid extract gtt. iij-viij. 
In very painful irritations in larynx [Lewin) ; in hypersesthe- 



96 ARTICLES OP THE MATERIA MEDICA 

sia of larynx ( Waldenburg). In irritative coughs. In asthma 
(Da Costa). 

37. Tinct. Belladonna. 
In nightly irritative coughs of children (Sales-Cfirons, Blache). 

38. Atropine Sulphas. 

Dose : J gr. to 20 ounces of water. 

According to Fieber, unnecessary and dangerous. 

39. Tinct. Stramonii. 

Diseases. — Asthma. Same as other narcotics (Lcwiri). 

40. Tinct. Digitalis. 
Diseases. — Same as other sedatives (Lewin). 

41. Tinct. Lobelia Inflata. 
Diseases. — Asthma. Same diseases as other sedatives (Lewin). 

42. Tinct. Opii Camphorata. 
Diseases. — Irritable coughs ; as a sedative in painful affections 
of upper air-passages. ♦ 

43. Glycerina. 

Diseases. — In inflammation of bronchi. In pertussis (Fieber). 
In dry cough of phthisis (Leiblinger). 

"With tannin (1 pt. tannin, 50 parts glycerine, 100 parts water) 
to soothe irritation from inflammation of the pharynx, particu- 
larly if applied in the first stage (Demarquay). Its antiseptic 
qualities destroy the fetid odor frequently exhaled by patients 
laboring under certain diseases of the pharynx and palate. 

In laryngitis and tracheitis, associated with hoarseness and loss 
of voice (Scott Alison). 

44. Oleum Terebinthina Kectif. 

Dose : Gtt. j-ij to ounce of warm water. 

In the chronic catarrh of emphysema (Leiblinger). Chronic 
bronchitis with offensive secretions. Bronchorrhcea. Gangrene 
of lungs. 



SUITABLE FOR NEBULIZATION. 97 



45. Oleum Cadinum. 

Dose : Gtt. j-ij to ounce of warm water. 
Chronic catarrh of emphysema (Leiblinger). 

46. Ol. Cubebs. 

In the same affections as the oil of turpentine ( Trousseau), 

47. Ol. Copaiba. 

In the same affections as the oil of turpentine [Trousseau). 

48. Oleum Oliv,e. 

In an oleaginous mixture with gum arabic in dry cough, in bron- 
chitis, and in whooping cough (Fieber, Leiblinger). 

49. Oleum Morrhute. 

This has been used in phthisis, &c. Makes the room smell too 
unpleasantly to be much used in private practice. 

50. Oleum Pint. 

This has been used in alcohol by Lewin as excitant in aphonia, 
but without material result. 

51. Camphora. 
With mucilage of gum Arabic in the putrid expectoration of 
phthisis [Fieber) ; but must be discontinued on the appearance of 
congestion or irritation. 

52. Quinine Sulphas. 

Dose : \-1 to the ounce of water. 

Used by Pieber in a regularly returning paroxysmal cough in 
a consumptive female. Quin. sulph., grs. ij ; tr. opii, gtt. vij ; alu- 
menis, grs. v; aq. font. f^j. On the same day in which it was 
given haemoptysis ensued, but whether the result of pulmonary 
congestion due to the quinia is uncertain. 

Used in intermittent fever by Ancelon [La Rev. Medicale, t. 4, 
pp. 598-601). 

Used in intermittent fever by Sales-Girons (Gazette Medicale, 
Sept. 8th, 1866). In tuberculosis [Sales-Girons). 

9 



98 



53. Acidum Carbolicum. 

Dose: Gtt. iii-x to ounce of water. 

In all stages of phthisis ( Wolfe, Lange). 

54. Mineral Waters 

At "Wistinghausen. In laryngitis and pharyngitis with viscid 
secretion and troublesome expectoration. First stage of phthisis 
(Auphari). 

Sulphurous Waters: In hoarseness. Granular pharyngitis. An- 
gina tonsillaris. Granular laryngitis and pharyngitis. Aphonia. 
Spasm of the glottis. Bronchial catarrh. Asthma. Phthisis 
[Sales- Girons). 

Spengler thinks these mineral waters restore the functions of 
the ciliary epithelium. 






CHAPTER V. 

DISEASES TO THE TREATMENT OF WHICH INHALATIONS 
OF NEBULIZED SOLUTIONS ARE APPLICABLE. 

Sales-Girons considers inhalations in this form in- 
dicated in acute and chronic diseases of the pharynx, 
larynx, trachea, bronchi, and lungs ; in nasal catarrh, 
in asthma, in tuberculosis; also in acute tonsillitis, 
pharyngitis, bronchitis, pneumonia, simple and pseudo- 
membranous angina, and croup. At first he employed 
the method in chronic affections only, and the earlier 
remedies resorted to were the sulphurous waters of Eaux- 
Bonnes, Pierrefonds, de Labassere, &c. ; and inasmuch 
as the treatment was pursued at these various watering- 
places, the plan was that the patients should drink one 
glass of the mineral water every morning upon the 
empty stomach, and afterwards inhale a certain quan- 
tity broken up into spray by the pulverisateur. 

Subsequently he added to his materia medica tar 
water, salt and water, and solutions containing iodine 
and chlorine, and finally he added the emollients, sed- 
atives, and antiseptics, the chloride of iron in cases 
of haemoptysis, and quinine as antiseptic in the last 
stages of tuberculosis. The duration of the inhalation 
depended on the condition of the patient, the stage of 
the disease, and the nature of the remedy. In chronic 
affections of the respiratory organs, where sulphurous 



100 DISEASES TO WHICH NEBULIZED 

waters, tar-water, and emollient remedies were em- 
ployed, the sitting continued some twenty minutes, — the 
time ordinarily consumed in nebulizing a glass of the 
mineral water. The inhalations were given twice a day, 
the first one in the morning before meals, and the second 
towards evening. When deemed advisable, and well 
borne by the patient, a third inhalation was permitted 
in the afternoon. 

Briau (Gazette Hebdomad aire, 1861, No. xv, p. 229) 
gives the results arrived at by himself in 49 cases, in all 
of which he employed the apparatus of Sales-Girons, 
the patient being seated in close proximity to the spray 
as it left the point of nebulization, and breathing it in 
slowly and deeply. In no instance was cough or other 
irritation induced. Some of the cases experienced a 
sense of tickling referred to the region of the base of 
the epiglottis. With the exception of one young lady 
who felt unwell for a few minutes without assignable 
cause, they all bore the inhalations well. 

All other treatment was abandoned for the time, save 
drinking th'e mineral waters of the resort. 

Of the 49 cases there were 

28 of simple or granular pharyngitis. 

2 of syphilitic plaques, with pulmonary tuberculosis. 

2 of simple ulceration of the larynx. 

2 of nervous aphonia. 

6 of chronic bronchitis. 

4 of pulmonary tuberculosis with pharyngitis. 

2 of uncomplicated pulmonary tuberculosis. 

3 of haemoptysis without discoverable pulmonary le- 
sion. 

Positive results were observed only in the two syph- 
ilitic cases, but without amelioration of their pulmonary 



INHALATIONS ARE APPLICABLE. 101 

symptoms. Both patients had drunk the mineral waters 
for fourteen days without the slightest beneficial effect 
upon the local affection ; but after the fifth inhalation 
the inflammation began to diminish, and soon subsided 
entirely. One of the cases, however, was at the same 
time under the use of the protiodide of mercury. 

In the other cases of pharyngeal and laryngeal dis- 
ease, Briau acknowledges no other effect than that 
which could be attributed to an ordinary gargle, the 
better for being a running water gargle, and of very 
long duration. 

He noticed no effect whatever in the cases of pul- 
monary disease which he could attribute to the new 
method. 

The majority of the patients took one inhalation daily 
of from fifteen to forty-five minutes' duration. Three of 
the cases of laryngeal disease took two inhalations daily. 
One of these was a case of ulceration from impaction 
in the left ventricle of a husk of corn, minute portions 
of which were coughed out at intervals. This patient 
had fifty-three stances in one month. Another was a 
case of functional aphonia, in which forty-two stances 
were tried ; and the third was hoarseness from a non- 
specific ulcer on one of the true vocal cords. 

These patients were made to inhale with the head 
inclined forwards, although the observer admits that 
the spray might have had better access to the larynx 
had their heads been inclined backwards. 

In valuing these observations of Briau it is to be re- 
membered that he was opposed to the method. (See 
page 41.) 



9* 



102 DISEASES TO WHICH NEBULIZED 

Coryza. 

By closing the mouth and giving the head the proper 
inclination, the nebulized spray can be readily inspired 
into the nostrils. 

Waldenburg reports favorable results with solutions 
of common salt, and of muriate of ammonia, in that form 
of coryza known as the dry snuffles. 

The profuse secretion of coryza can be diminished by 
inhalations of alum, which, by its antiseptic properties, 
will destroy fetor when present. 

Acute Inflammation of the Fauces and Pharynx. 

Local applications by means of gargles have long 
been employed in these aifections ; but independent of 
the pain which frequently follows attempts to gargle 
under such circumstances, it is impossible to gargle in 
such a manner that the fluid shall come in contact with 
the posterior pharyngeal wall, without a voluntary at- 
tempt to swallow, which produces but imperfect con- 
tact. One can prove this by gargling with any colored 
solution, such as indigo or aniline, and then examining 
the parts before a mirror. He will find the roof of the 
mouth, tongue, and soft palate covered with the color 
employed, while the deeper parts of the throat are not 
discolored. 

Hence, in the expressive language of Dr. Da Costa, 
" for really valuable purposes the day of the gargle has 
passed," for by means of this new method we can direct 
the spray to any desired point, and secure its contact 
without any other co-operation on the part of the pa- 
tient than that of simply opening his mouth to permit 
ingress. 



INHALATIONS ARE APPLICABLE. 103 

The articles principally employed in these affections 
are tannin and alum. I prefer the latter in acute in- 
flammations generally, independent of its less unpleas- 
ant taste. The solution may be of the strength of from 
five to twenty grains to the ounce of water, and the in- 
halations should be frequently renewed, say an ounce 
of such a solution should be nebulized five or six times 
a day, and the patient inhale as much of it as possible. 
Better effects usually follow at a low temperature, but 
the solution can be warmed if desirable. If there is a 
great deal of pain the extract of opium, grs. J to gr. j, 
can be advantageously added to the solution ; and in- 
deed, in some cases, an opiate inhalation of itself will 
be of great value. 

In a severe case of angina tonsillaris in a lady of this 
city who is subject to ulcerative attacks of tonsillitis, 
and several members of whose family I was attending 
during the epidemic of influenza of last year, I suc- 
ceeded in aborting the disease by strong inhalations of 
opium, employing a solution of five grains of the watery 
extract to the ounce of distilled water, and repeating 
half the quantity at intervals of two hours. The re- 
lief to the pain, difficulty of breathing, &c, was very 
prompt, narcotism soon ensued, and after a sound sleep 
deglutition was again practicable, and inhalations of 
warm water simply were substituted for the opiate in- 
halations, of which she had taken but three, containing 
ten grains of the extract of opium ; but it must be re- 
membered in connection, that the patient was in bed, 
took the inhalations from the side, and the probability 
is that not more than three grains at the utmost gained 
access to the parts, some of it being diffused in the air, 



104 DISEASES TO WHICH NEBULIZED 

and a good deal that entered the mouth being driven 
out again in expiration. 

In the milder cases of acute angina, inhalations of 
lukewarm water, or milk and water, will often suffice. 

In inhalations for diseases of the pharynx the inspir- 
ations should be very light, and for those of the fauces 
hardly any inspiratory effort is necessary, the natural 
movement of inspiration being sufficient. 

Prof. Seitz has seen the best results in angina tonsil- 
laris from nebulized ice-water (Fieber, op. cit., p. 106). 

I have frequently been able to reduce recent inflam- 
mation of the tonsils very promptly, in those subject to 
tonsillitis, by the inhalation of a solution of alum, five 
to ten grains to the ounce, repeated every hour or two 
hours until the desired effect had been produced. I have 
also succeeded with solutions of sulphate of copper three 
or four times daily. Of course, if a purge was neces- 
sary, it was directed to be taken. 

In these inflammatory cases I like to direct the spray 
by means of properly curved nebulizers. 



Chronic Inflammations of the Fauces and Pharynx. 

For these affections as ordinarily met with, I rather 
prefer the effects of a solution of tannin in the propor- 
tion of gr. j — x to the ounce of distilled water. It is 
better to make the solution as it is required, to prevent 
change into gallic acid, and to filter the solution before 
using it. In my own hands, tannin has given better 
satisfaction than alum, though by many they are used 
indifferently. I think tannin produces a more chronic 
effect than alum, and this is what is desired. Here the 
inhalations need not exceed two a day, for the disease 



INHALATIONS ARE APPLICABLE. 105 

will require more or less time for removal, and hence 
the superiority of the effect of tannin. 

In very obstinate cases, with alteration, thickening 
of the mucous membrane, I have seen good results 
from morning and evening inhalations of a weak solu- 
tion of the sulphate of zinc, a grain or two, to two, 
three, or four ounces of distilled water. In obstinate 
cases, which have resisted these measures, I have some- 
times employed a solution of iodine with advantage. 
In the dry variety of the disease, pharyngitis sicca, I 
can testify to good results from a solution of muriate 
of ammonia; though in one instance, of long standing, 
in a baker, where the sal-ammoniac failed, daily inha- 
lations of a solution of iodine, ten drops of the tincture 
to the ounce of water, morning and evening, accom- 
plished the result ; and the man was ab]e to resume his 
employment after having been compelled to abandon it 
for more than two years. 

I have seen several cases of pharyngitis sicca in shop- 
keepers, which have been promptly relieved by inha- 
lations of sal-ammoniac. In these cases, I have ad- 
vised the inhalations to be taken at the place of business, 
and three times a day, — before opening the store, at 
noon, and before closing. 

Wherever there has been ulceration, I have employed 
local applications of nitrate of silver or other protective 
to the ulcerated spots, for such applications are much 
more effectual than the spray. 

I have met with one or two cases of chronic inflam- 
mation of the fauces and pharynx in stokers, exposed 
for several hours at a time to a hot fire ; and have found 
the inhalation of the spray of warm water, or warmed 
infusion of wild cherry bark, answer an admirable pur- 



106 DISEASES TO WHICH NEBULIZED 

pose in relieving the dryness of throat and frequent 
disposition to cough, to which they were subject. 

I have, however, had one case under treatment for 
many months, of chronic pharyngitis with a relaxed 
state of the mucous membrane of several years' stand- 
ing, in a brick mason, which has resisted all the treat- 
ment detailed, as well as the employment in the same 
manner of the bromides of potassium and ammonium 
separately and together, alone and in combination with 
iodide of potassium, and almost the entire range of seda- 
tives and alteratives ; with and without systemic treat- 
ment. Temporary amelioration has occasionally fol- 
lowed the employment of a new remedy ; but the great- 
est advantage has been experienced during the healing 
of a blister on the outside of the neck produced by the 
inunction of Croton oil. 

It will be often found desirable to ring the changes 
on various astringent and alterant applications, as the 
parts become accustomed to their influence one after 
the other. 

Inhalations of a weak solution of the nitrate of sil- 
ver have been employed with success in cases of ob- 
stinate chronic pharyngitis. I have had no experience 
with the article in that form for this affection, except 
when an accompaniment of laryngeal phthisis. 

Hypertr opined Tonsils. 

Inhalations of tannin, tincture of the chloride of iron, 
&c, come in play very well after excision of these 
glands, as astringents and as haemostatics to arrest 
profuse hemorrhage after the operation. 



INHALATIONS ARE APPLICABLE. 107 

Syphilitic Angina. 

This affection has been treated with good effects by 
Briau, Demarquay, Schnitzler, Waldenburg, and Lew- 
in, by inhalations of a solution of corrosive sublimate, 
one or two grains to the ounce of distilled water. 

Granular Pharyngitis. 

Demarquay found great benefit in a dozen of cases 
from the inhalation of tannin, 1 part to 100 of water, 
with the use of the waters of Eaux-Bonnes, where the 
treatment was instituted. 

In general, the condition of the patients improved 
under the influence of three to four nebulizations a day. 
Sometimes improvement began in a single day. In from 
twenty to twenty-five days, he cured a young lawyer, 
whose voice lost its power on moderate exercise, of a 
dryness of the throat, with slight but long-continued 
cough and bloody sputa. Examination of the phar- 
ynx showed a chronic inflammation of the entire 
region, with a normal development of the pharyngeal 
glands. Trousseau witnessed this case. 

Demarquay, however, does not consider this treat- 
ment a radical cure for granular pharyngitis, the cause 
of which he considers to exist deeper in the organism. 

Pharyngo- Laryngitis. 

Dr. Johann Schnitzler reports {Wiener Medicinal- 
Halle, 1862, No. 48, p. 442) one case in an individual 
about 30 years of age. Marked improvement ensued 
in a few days from inhalations of tannin, five grains to 
the ounce of water. This was not considered a curable 



108 DISEASES TO WHICH NEBULIZED 

case, inasmuch as the patient would not give up the 
abuse of spirituous drinks, to which his catarrh was 
partly attributable. [Lewin, op. eit, p. 259.) 

I have repeatedly verified the experience of Schnitz- 
ler, Waldeman, Fieber, Lewin, and others, as to the 
effect of astringent inhalations in these affections ; and, 
occasionally, the result has been so prompt as to stag- 
ger credence ; and the like of which, certainly, has not 
attended other treatment. A couple of cases from my 
note-book in illustration : 

C. F. H n, a stout, hearty driver of an express 

wagon, contracted an intense laryngitis and pharyn- 
gitis from exposure incident to his employment. When 
he was sent to me, April 6th, 1866, after the disease 
had existed three or four days, his voice was very 
hoarse, and he complained of great pain in swallowing. 
Laryngoscopy revealed intense congestion of the laryn- 
geal mucous membrane, including that covering the 
vocal cords. He inhaled a nebulized solution of alum 
during fifteen minutes with great relief, and the follow- 
ing day the pain and dysphagia had left him, the voice 
was almost natural, and the parts had assumed their 
normal appearance. 

Mrs. E S n, came to me on Saturday night, 

April 14th, 1866. Two nights previously, this lady 
had taken cold. There was great oppression of breath- 
ing, and on examination I found her to be suffering 
from general faucitis, submucous laryngitis, with sub- 
mucous infiltration of the aryteno-epiglottic folds. 

I projected some spray of ether upon the fauces ; and 
shortly after caused her to inhale from the steam- 
nebulizer, one ounce of a saturated solution of chlorate 
of potassa. The following morning she returned ; 



INHALATIONS ARE APPLICABLE. 109 

there was still a little hoarseness, but the other symp- 
toms were gone, so that, to all intents and purposes, 
she was well. I applied within the larynx a douche of 
sulphate of zinc, 15 grs. to f Sj, to stimulate the mu- 
cous membrane ; and after that the patient did not 
return. 

Mrs. F n, of this city, applied to me May 1, 

1866, recommended by the express driver, whose case 
has been mentioned. She had been suifering from sore 
throat for several days. I found infiltration of the 
aryteno-epiglottic folds and of the mucous membrane 
covering the cartilages of Santorini. Inhalations of 
alum water were administered, and she was directed to 
take three comp. cath. pills at bedtime. The next day 
she returned much the better for her purge and her 
inhalation. The inhalation of alum was repeated in 
the evening, and the day following she was sufficiently 
well to resume her domestic employments and dispense 
with professional services. 

I might mention in this place an unusual case of 
faucitis which occurred in a young lady of this city 
under my care, in which the disease was confined to one 
side, cut off short at the mesial line, so much so that 
the uvula presented a forked-like appearance, and in- 
deed was mistaken by me for a bifid uvula on account 
of the inflammation and swelling on that side, and 
dragging the other side down without implicating it in 
the inflammation. During the treatment, I showed this 
case to several professional gentlemen, to whom it was 
as novel as to myself. Nitrate of silver gr. xx ad f^j, 
was projected on the parts from a Bergson's apparatus, 
and in ten days the parts began to heal rapidly, the 

10 



110 DISEASES TO WHICH NEBULIZED 

general health improved, and the emaciated patient re- 
gained her embonpoint. 

Follicular Pharyngo- Laryngitis. 

In this form of sore throat, to which clergymen and 
other public speakers are subject, I have found great 
benefit from the continued use of inhalations of tannin 
in weak solution. Sometimes it will be necessary to 
make a change in the remedy, and employ some other 
astringent for a time, and then resort again to tan- 
nin. Good results have followed the inhalation of 
a weak solution of opium or hyoscyamus, at a some- 
what elevated temperature, just before employment of 
the voice. I have found this advice of value to lawyers 
and public performers subject to this and kindred affec- 
tions. The permanent cure of this affection necessitates 
the withdrawal for a time from exposure to the causes 
which produced the trouble in the first instance. I 
cannot affirm that I know of a single case in which a 
permanent cure has been effected, though I have treated 
several ; all of whom report greater relief from the 
inhalations than from any previous treatment, and 
resort to their apparatus as they find they have occa- 
sion for it. 

Acute Laryngeal Catarrh. 
Siegle reports (op. cit. 52) that he employed in many 
cases inhalations of tannin and alum, but not with much 
benefit, unless he dieted the patients and kept them 
abed. When the severer symptoms had diminished, 
and the main object was to lessen the difficult expecto- 
ration, he found the greatest advantage from a solution 
of sal ammoniac, 4 grs. to the ounce of distilled water, 



INHALATIONS ARE APPLICABLE. Ill 

several times daily, in close proximity to the appar- 
atus. 

Waldenburg found the best result from a solution of 
common salt, 4 to 10 grs. to the ounce of water. 

Fieber reports prompt success from sulphate of zinc 
with the addition of laudanum. The inhalation of alum 
water, to which a little narcotic may be added, will usu- 
ally induce a great deal of comfort. Inhalations of 
warm water often afford a feeling of relief. 

Biegel reports several cases cured by inhalation of 
solutions of alum. 

Chronic Laryngitis. 

Dr. Johann Schnitzler ( Wiener Medicin. Halle, 
1862, No. 48) reports five cases. Three were treated 
with inhalations of alum, two with tannin ; rapid and 
marked improvement in all. Improved appearances 
noted with the laryngoscope ; the mucous membrane 
appeared paler shortly after each inhalation than be- 
fore. In one case of chronic hoarseness, before inhala- 
tion, the vocal cords were covered with accumulations 
of mucus, and after inhalation they were cleaned off, 
and the voice had become clearer likewise. 

Tannin, the salts of iron, and chlorate of potassa, 
are the remedies most frequently recommended for in- 
halation in this form of disease, and may be adequate 
to a cure when there is no constitutional implication. 

Laryngeal Phthisis. 

Demarquay reports great improvement from an in- 
halation of tannin, 1 part to 100 of water, in a case of 
laryngeal phthisis, in which deglutition was very pain- 
ful and almost impossible. 

In one case of laryngeal phthisis which terminated 



112 DISEASES TO WHICH NEBULIZED 

fatally under my own care, as indeed have all the cases 
which I have attended to their termination, great tem- 
porary relief followed for a long time inhalations of ni- 
trate of silver, a grain to the ounce of distilled water. 

For the dysphagia so constant an attendant upon 
these cases, I have found considerable relief from in- 
halations containing opium or some other narcotic. 

In some cases, where violent fits of coughing follow 
almost every attempt to swallow, I have seen relief 
from inhalations of this kind, ringing the changes upon 
the astringent and narcotic preparations, as the system 
became less influenced by the article under employ- 
ment. 

In one case of laryngeal phthisis, in a glass grinder, 
under the care of Dr. William H. Pancoast, of this 
city, which I had the opportunity of observing fre- 
quently, considerable temporary benefit accrued from 
the inhalation at different times of astringents, narco- 
tics, and of lime water. This case also, terminated 
fatally. 

Lewin has recommended in these affections, the in- 
halation of a nebulized solution of nitrate of silver, gr. 
1-2 to the ounce of distilled water. I have once or 
twice resorted to them, but the beneficial effect did not 
compare to that of local medication by the probang, 
with a strong solution of the salt. 

Inhalations of Solutions of Nitrate of Silver in Chronic 
Diseases of the Air-Passages. 

Dr. Ludwig Joseph, of Breslau, reports (Deutsche 
KliniJc, May 26th, 1866) that he has employed inhala- 
tions of nebulized fluids in chronic affections of the 
larynx, bronchi, and lungs, the medicament principally 



INHALATIONS ARE APPLICABLE. 113 

used being solutions of nitrate of silver of various 
strengths. With Tobold he has experienced more 
benefit from them in affections of the bronchi and of 
the lungs, than in affections of the larynx, where topical 
treatment can be better carried out, and with more 
benefit. The effect of the nebulized fluids in laryn- 
geal complaints is too weak, and not sufficiently ener- 
getic. Their mild influence is more applicable to af- 
fections of the bronchial tubes, and of the air-cells, 
where powerful effects are not required. 

In chronic bronchial catarrh, with profuse secretion 
from the bronchial mucous membrane, and in bronchi- 
ectasie, he found the inhalation of nitrate of silver of 
incontestable value. He found it lessen the abnormal 
secretion from the mucous membrane, stimulate the 
membrane by its slight irritation, and thus gradually 
assist the resumption of its normal functions. It seems 
also to tone up the bronchial mucous membrane. The 
effect is not equal in all constitutions, but is best in 
slow, sleepy, torpid, scrofulous individuals. It is well 
borne in well-founded cases of suspected tuberculosis. 
Dr. Joseph has treated several cases of frank tubercu- 
losis, demonstrable by physical exploration, in this 
manner, with the result of diminishing the amount of 
ulcerative processes, and promoting general improve- 
ment. In these cases the general condition of the pa- 
tients was favorable. 

Among others, the following case of chronic bron- 
chial catarrh, with suspicion of tubercle, is of great 
interest: 

P K , of Bremen, get. 29, a merchant, small 

in build, of delicate frame, well nurtured, came under 
treatment September, 1864, having failed to obtain re- 

10* 



114 DISEASES TO WHICH NEBULIZED 

lief from his disease, from various remedies that had 
been judiciously employed. He was made to inhale a 
solution of nitrate of silver, five grains to the ounce of 
water; and within three weeks the expectoration ceased 
entirely, and at the date of writing, twenty months after, 
there was not a trace of cough or of expectoration. 

Dr. Joseph has never seen any direct injury from 
the inhalations of these solutions of nitrate of silver. 
At the first sittings, the patients feel an irritation along 
the course of the trachea, continued sometimes as far 
as the xiphoid process of the sternum, — a feeling of 
rawness. Immediately after the inhalation, a quantity 
of thick tenacious secretion is often expectorated with 
ease. 

He reports a case of bronchiectasie (dilatation of the 
minuter bronchi) in which the most remarkable im- 
provement followed the inhalation, for six weeks, of 
solutions of nitrate of silver, gradually increased in 
strength to a scruple of the salt to the ounce of dis- 
tilled water. 

He has used, with good results, in painful affections, 
a solution of the acetate of morphia in bitter almond 
and fennel-seed water, as recommended by Fieber and 
others. 

Croup. 

Dr. Johann Schnitzler {op. cit.) reports two cases 
of croup, treated with inhalations of a solution of brom- 
ide of potassium ; one of which terminated fatally, the 
other resulting favorably. 

1st case. This was a three-year-old boy, a sister of 
whom had recently died of croup. The Doctor saw 
the child on the third day of the disease. It was then 






INHALATIONS ARE APPLICABLE. 115 

lying in a state of apathy upon its mother's arms, th« 
countenance pale, the eyelids half closed, the hands 
hanging by the side. Suddenly the child became un- 
easy, put its hands up to its throat, and began to cry 
and to cough, but both cough and voice were toneless ; 
the child could be seen to cry and to cough, but it could 
hardly be heard to do so. The breathing was difficult, 
and marked by the peculiar rales of croup ; the pulse 
was small, barely to be counted, and gliding from under 
the finger. Examining the fauces, large white patches 
[plaques) covered the tonsils and the entire posterior pha- 
ryngeal wall. During the examination, the breathing 
became more difficult, and the child hurriedly but 
vainly gasped for air. An emetic had no effect. In 
spite of the unfavorable prognosis, an attempt was 
made to save the patient, and an inhalation of a solu- 
tion of bromide of potassium, five grains to the ounce, 
was instituted. As a large proportion of the fluid 
struck the pharynx, it detached much of the patches, 
which was spat out. For two hours the child felt 
better, but soon the threatening symptoms recurred 
again, and in spite of five repetitions of the inhalation, 
the child died that night with symptoms of suffocation. 
2d ease. This was a well-developed child, six months 
old, with pseudo-membranous croup. Inhalations of 
bromide of potassium, ten grains to the ounce of water, 
were administered. After fifty to sixty inspirations, 
instead of the rales, a flapping respiration ensued, as 
from the air passing and repassing a membrane par- 
tially detached. Soon there was so much improvement, 
that the cough was less frequent and the voice less 
hoarse. This improvement continued four or five hours, 
when the previous symptoms returned. Another inhala- 



116 DISEASES TO WHICH NEBULIZED 

fcion produced the same relief, which continued through- 
out the entire night. The following morning, the child's 
appearance was quieter, the pulse had gone down from 
130 in the minute to 100, and voice and cough were 
somewhat hoarser, but the cough no longer so severe. 
Another inhalation produced again the same effect as 
before, but to a greater extent ; another inhalation was 
given in the evening ; followed by quieter sleep. Pulse 
in the morning 96-100 ; two inhalations during the day. 
The next morning, the fourth of the treatment, after 
the child had in all taken six inhalations, two ounces 
each time, the breathing had become quiet, pulse not 
accelerated, voice nearly as clear as natural, and the 
cough almost entirely gone. 

Prof. Biermer, of Berne, relates (Schweizerische 
Zeitungfilr Heilkunde, 1864, p. 157, Lewin, op. cit. p. 
287 ; et al.) the following interesting case of laryngeal 
croup in the adult, cured by inhalations of warm watery 
vapor and of lime-water, 

A young girl of eighteen years of age, was treated 
in the beginning of March, 1864, for what appeared 
to be a simple laryngitis. During breakfast on the 
morning of March 13th, there suddenly ensued an in- 
tense paroxysm of cough, with appearance of asphyxia, 
cyanosis, cool extremities, loss of consciousness, and 
complete insensibility. The physician who was called 
in the emergency, recognized the necessity of imme- 
diate resort to some powerful restorative, and applied 
a hot hammer upon the breast; but without exciting 
any reaction. Under continued severe irritation of the 
skin, and the use of liq. ammon. anisati, the patient 
gradually came to, and eventually coughed up a con- 
siderable quantity of croup membrane; after which the 



INHALATIONS ARE APPLICABLE. 117 

respiration became easier. After this attack, the 
breathing remained stenotic, rattling, and whistling. 
On her reception into the hospital, the morning of the 
same day, the countenance was still very livid, the eyes 
dull, the pulse very feeble and small, the nose and ex- 
tremities cool, and the crowing respiration accompanied 
by paroxysms of cough, during which, pseudo-mem- 
brane was expectorated. One patch was ring-shaped, 
having received the impression from one of the rings 
of the trachea. External irritation, and calomel, suc- 
ceeded in diminishing the dyspnoea. t The next morn- 
ing, intense dyspnoea again set in, accompanied with 
the ordinary croupal long-drawn inspiration, with the 
employment of all the auxiliary muscles, and marked 
inspiratory incurbation of the scrobiculus cordis. In 
spite of the vomiting induced by an emetic, the orthop- 
noetic symptoms increased, with lividity of the counte- 
nance and great distress, during the continuance of the 
cough. Under these circumstances, in order to moisten 
the dry mucous membrane of the air-passages, the in- 
halation of warm water, broken up by the pulverisa- 
teur, was employed. This agreed with the patient so 
well, that finally boiling water was permitted to be 
nebulized through the apparatus, for the patient de- 
clared that the warmest steam possible afforded her the 
greatest relief. She inhaled the warm steam for an 
hour with great eagerness, and expectorated to a con- 
siderable extent, while the dryness and difficulty of 
breathing gradually lessened. Then a stormy suffoca- 
tive paroxysm of cough came on, during which a con- 
siderable quantity of mucus and pieces of croupal mem- 
brane were expelled. The patient then breathed much 
more freely, and felt greatly relieved. From this time 



118 DISEASES TO WHICH NEBULIZED 

on, she inhaled every two hours warm lime-water, in 
the proportion of one part to thirty, each inhalation 
continuing a quarter of an hour. From this time 
forward, the symptoms of croup declined more and 
more, and with a profuse expectoration of thick, 
crumby, yellow, purulent masses ; the fever abated, 
and convalescence began the following day ; the apho- 
nia, however, continuing until the 9th of April, when 
it also began to disappear. 

M. Biermer, and all those who watched the progress 
of this case, wer« convinced {Brit. $ For. Med.-Ohir. 
Review, July, 1865, from Bui. Gen. de Therap., 
April 15, 1865) that the inhalations had a solvent 
effect upon the false membrane ; but the Professor 
does not recommend an exclusive adoption of this local 
treatment, which softens and detaches the exudations, 
but does not reach the cause of the disease, which must 
be combated by constitutional remedies, calomel being 
considered the chief. 

Prof. Biermer was aware of the case of croup re- 
ported by Siegle, as cured by inhalation of nebulized 
water, very warm, and he attributes the happy result 
chiefly to the high temperature, especially when lime : 
water is added to it. 

Prof. Biermer was led to the employment of lime- 
water from the statement of M. Kuchenmeister, of 
Dresden, that diphtheritic membranes are rapidly dis- 
solved in lime-water. This was confirmed by Forster, 
of Dresden, and also by Prof. Biermer, who repeated 
Kuchenmeister' s experiments before the students of his 
clinical lectures in the University of Berne, placing 
some pseudo-membranous exudations in a small glass 
of lime-water ; and they disappeared before the eyes 



INHALATIONS ARE APPLICABLE. 119 

of the students in from ten to fifteen minutes, leaving 
only a slight sediment in the bottom of the glass. 

Dr. Brauser, of Ratisbon, has also lately published 
(quoted in Brit. $> For. Med.-Chir. Rev., July, 1865) 
a case of croup in a child of four and a half years old, 
treated in the same manner, a perfect cure. M. Brau- 
ser insists on the necessity of using the inhalations 
hot. 

Siegle (op. cit., p. 60) reports a very severe case 
of membranous croup with impending death, in a child 
two years of age, for whom he had tried all the usual 
remedies in vain. He was about instituting inhala- 
tions of nitrate of silver or tannin, when the rapidly 
threatening symptoms of want of air seemed to him to 
be less due to obstruction by croupal membrane, than 
to ineifectual attempts to detach the accumulating mu- 
cus ; to assist these, he administered inhalations of 
warm steam, and very soon the patient began to spit 
out portions of the membrane. After an inhalation of 
a quarter of an hour, the child breathed more freely, 
and after twenty-four hours, during which it was more 
or less kept up day and night, the child bringing 
up a good deal of mucus, and shreds of croup mem- 
brane, which the mother removed from its mouth with 
her finger, the life of the little patient was saved. 

Siegle also reports another case of croup in a little 
boy of five years of age, in which several inhalations 
of tannin were taken daily by the little patient, who 
quietly submitted to the new method ; but in spite of 
the amendment of some of the most desperate symp- 
toms, the patient died. 

Barthez (Traitement des ang. diphth. par la pulv., 
Paris, 1861, Lewin, op. cit. p. 224-235) details four 



120 DISEASES TO WHICH NEBULIZED 

cases of croup, treated by him at the Hopital des En- 
fants, St. Eugenie, with inhalations of tannin, 5-10 
parts to 100 parts of water, from eight to twenty times 
a day, fifteen to twenty minutes at a time ; in which he 
observed the excellent effect of the remedy upon the 
membranous exudation. Respiration became freer, 
the dyspnoea diminished, and the suffocative paroxysms 
disappeared. Two of the cases terminated fatally, in 
consequence of the systemic poisoning, for in one of 
the cases where the presence of the membrane had 
been diagnosed, no trace of it could be found upon 
post-mortem examination. 

The first case, a girl set. 4 J, was one of general diph- 
theritis, with pseudo-membranous exudation in the nos- 
trils, upon the lips, in the mouth, larynx, and doubtless 
in the bronchi. Death occurred on the sixth day after 
commencing treatment, and the twelfth of the disease. 
At the autopsy there was no relic of pseudo-membrane 
anywhere on the tonsils, pharynx, larynx, trachea, or 
bronchi. 
, This case showed us, remarks Barthez : 

1st. A modification of the local appearances after 24 
hours, under the influence of the nebulized solution of 
tannin. 

2d. The local improvement the greater, the more the 
pseudo-membrane came in contact with the nebula. 

3d. The corresponding diminution of the general 
symptoms of diphtheritic intoxication, with the diminu- 
tion of the local symptoms. 

The second case, a boy set. 5J, was diphtheritis of the 
pharynx, larynx, and nostrils. Internal treatment with 
large doses of sesquichloride of iron, and inhalations of 
a tannin solution ; immediate and permanent benefit by 



INHALATIONS ARE APPLICABLE. 121 

the inhalation of tannin ; improvement in the croupal 
symptoms while the systemic poisoning rapidly increased, 
and the child died on the twelfth day of the disease, and 
tenth of the treatment. 

The third case, a boy set. 3, was one of angina mem- 
branacea — croup in the second stage. Treatment by in- 
halation began on the fourth day, with repeated inha- 
lations of a nebulized solution of tannin. For three days 
the disease remained stationary; then improvement rap- 
idly ensued, with recovery on the ninth day. 

The fourth case, a girl get. 3J, was one of croup in 
the first stage, with pseudo-membranous exudation upon 
the tonsils, the soft palate, and the uvula. Prompt 
recovery on the fourth day of treatment by inhalation 
of a solution of tannin. 

Fieber [op. cit., p. 114), who, having translated Bar- 
thez' cases, treated fifteen cases of his own in the same 
manner, reports two-thirds of them cured, the remaining 
third having terminated fatally. He combats Barthez 
opinion as to the mechanical effect of the tannin, which, 
according to that observer, is to pucker the membrane, 
so that its edges roll over, and it thus becomes gradually 
detached ; and states that he has never seen this effect, 
but that the membrane appears to him to become, as it 
were, dissolved under the influence of the tannin. 

Dr. Da Costa [Essay on Inhalations, New York, 1867, 
p. 30) in commenting upon these* cases, remarks that 
when we look at the length of the treatment, it does not 
look as if the remedy had any marked solvent power, 
for dipththeritic membranes are not permanent struct- 
ures, but are very apt to disappear from the circumfer- 
ence to the centre within a week after their appearance ; 
and hence, if we accord any value to the treatment — 

11 



122 DISEASES TO WHICH NEBULIZED 

which, bearing in mind the usually fatal character of 
laryngeal diphtheria and the grave character of pseudo- 
membranous croup, we cannot totally refuse to do — we 
must also admit that the action is not rapid, and not 
what we might expect from a solvent ; nor can we over- 
look the effect of the water in the combination as a 
cleansing agent, and as tending to aid in removing and 
in expectorating the breaking-down textures, for in 
Siegle's hands the inhalation of pulverized warm water 
alone produced the greatest relief in an apparently hope- 
less case. 

My own experience with inhalation in croup is limited 
to a single severe case of catarrhal croup, in which the 
relief of very distressing symptoms repeatedly followed 
inhalation of lime-water. 

Dr. James Collins, of this city, furnished me with 
the following record of his experience with inhalations in 
croup : 

Pseudo-membranous Croup. — Mary E , set. 11 

months. Was called to the case November 18, 1866. 
Patient apparently beyond recovery. Lime inhalations 
employed with little or no effect, and the patient died. 

A. B , aet. 3 years. A robust, healthy child. 

Had been unwell for a few days, suffering from cough, 
neglecting its play, and becoming somewhat peevish ; 
but had shown no alarming symptoms until the previous 
night, when the cough became more brazen and spas- 
modic. I found the child with marked fever, dyspnoea, 
husky voice, distressing and spasmodic cough. On ex- 
amination I found the fauces lined w T ith an albuminous 
deposit. Lime-water inhalations were at once instituted, 
and a mustard bath, while one of the family was des- 
patched for an emetic ; but by the time it was procured 



INHALATIONS ARE APPLICABLE. 123 

the symptoms had abated so much that it was not deemed 
necessary to administer it. The cough loosened, and 
tough albuminous material was coughed up in large 
irregular masses, which readily spread out into flakes 
on being spat into water. The inhalations were con- 
tinued every two hours that night, and three times the 
following day, after which I found no other topical ap- 
plication necessary. The inhalations were continued 
from time to time, a mild purge administered, and tur- 
pentine sfupes applied to the back of the neck and the 
breast. The child steadily improved and recovered. 

Dr. Collins informs me that he has tried lime-water 
inhalations in several cases of simple spasmodic croup, 
with success in every instance. 

Diphtheria. 

Lewin records in detail [op. cit. 466-499) eighteen 
cases of diphtheria treated by him, in part with inhala- 
tions, of which number fifteen recovered. These results 
being remarkable, I consider it well worth while to in- 
sert a synopsis of the cases, their treatment, and the 
result. 

Case I. Margaret H., set. 4. Treatment began on 
the tenth day of the disease, when the symptoms were 
as follows : April 14— evening. Pulse, 120 ; respiration 
30 ; urine somewhat albuminous ; sleep good ; voice a 
little hoarse ; deglutition somewhat impeded ; cough 
trifling ; lymphatics of the neck on the right side swollen ; 
right tonsil covered with a deeply penetrating pseudo- 
membrane ; larynx copper-colored ; epiglottis swollen. 
Treatment : internally, chlorate of potassa 5j to f§v of 
water; locally, chromic acid 5jss. to fSj applied to the 
deposit ; by inhalation, chlorate of potash 5j to f§vj. 



124 DISEASES TO WHICH NEBULIZED 

Under this treatment the condition gradually improved, 
and the child was about to be discharged from observa- 
tion, when, on the fifth day of the treatment, she was 
attacked with rigors in the evening, followed by fever ; 
the next morning a deeply penetrating white exudation 
was observed on the left tonsil, which seemed to be 
drawn more deeply towards the larynx. The same 
treatment was reinstituted, and after a few days the 
child recovered entirely. 

Case II. Hannah F , set. 5, the sister of two 

boys recently dead of diphtheria. She was seen on the 
third day of the disease, when, May 29, her condition 
was as follows : pulse 120 ; respiration 28 ; urine 
slightly turbid ; sleep good ; voice and deglutition nor- 
mal ; no cough ; lymphatics on right side swollen ; 
grayish-white exudation on the right arch of the palate 
and upon the right tonsil, dipping down deep to its 
lower surface ; larynx copper-red ; the mucous membrane, 
especially upon the upper surface of the epiglottis, 
somewhat swollen. Treatment : internally, chlorate of 
potassa 5j to fgiv — a tablespoonful every hour ; locally, 
chromic acid 5ij to foj ; by inhalation, chlorate of potassa 
5ij to f§viij. By the 3d of June all the phenomena of 
disease had disappeared ; but on the 7th of June an 
alteration of the voice was noticed, and a difficulty in 
deglutition, fluids returning by the nose, owing to a par- 
tial paralysis of the soft palate, of which there was, 
under the use of iron, gradual restoration in four weeks. 

Case III Otto F., set. 3., brother of Case II. On 
the second day of the disease, May 29, he presented the 
following condition : pulse 112 ; respiration 26 ; sleep 
good ; voice normal ; deglutition somewhat impaired ; 
some cough ; lymphatics of neck swollen on both sides ; 



INHALATIONS ARE APPLICABLE. 125 

exudation on both sides of the pharynx, on the left side 
extending further towards the entrance into the larynx ; 
larynx somewhat congested, grayish-yellow slimy exu- 
dation on the free border of the epiglottis. Treatment : 
internally, Potas. chlor. 5j to f§iv, a papspoonful 
every two hours ; locally, cauterization with chromic 
acid 5ij to fSj ; by inhalation, potass, chlor. 5\j to fSviij. 
Recovery prompt. 

Case IV. Alfred B., set. 8. On the third day after 
having been taken with fever he began to cough ; this 
increased and assumed a barking tone. Tonsils covered 
with whitish-gray matter. Improvement followed an 
emetic and the application of leeches ; but on the next 
day the fever increased, the cough increased, hoarseness 
came on, and the medical attendant administered an 
emetic, again applied leeches, and gave two grains of 
calomel every other hour until twelve grains had been 
taken. June 12, the fifth day of the disease, the con- 
dition was as follows : pulse 126 ; respiration 34 ; no 
albumen in urine ; sleep broken by a barking cough ; 
some dysphagia ; lymphatics swollen on both sides of 
neck; the velum on the right side, from the attachment 
of the uvula over to the lower end of the tonsil, covered 
with gray-white pseudo-membrane ; left tonsil slightly 
affected ; the entire larynx, as far as could be seen, 
highly reddened, the upper surfaces of the arytenoid 
cartilages covered with thin gray-white exudations ; the 
vocal cords could not be seen. Treatment : internally, 
Potass, chloras. Sjss. to f§iv, — a papspoonful every two 
hours ; locally, cauterization with chromic acid 5\j to 
fSj ; by inhalation, potass, chloras. 5ij to foviij, two 
ounces every two hours. On the 15th the child was 
pronounced well. 

11* 



126 DISEASES TO WHICH NEBULIZED 

Case V. Hannah ]£., set. 3J, very delicate. Con- 
dition July 10th as follows : pulse 96 ; resp. 24 ; some 
albumen in urine ; sleep tolerable ; considerable hoarse- 
ness ; a moderate degree of dysphagia ; frequent cough ; 
lymphatics somewhat swollen ; considerable and deeply 
penetrating exudation upon both tonsils and arches ; 
mucous membrane of entire larynx and commencement 
of trachea, bright red ; epiglottis somewhat swollen. 
Treatment : internally, potass, chlor. 5\j to f§v ; locally, 
cauterization with chromic acid 5\j to f§j ; by inhala- 
tion, alumen 5\j to fSviij. The next day the voice 
had improved, the epiglottis was more swollen and in- 
flamed, but showed no exudation ; internal treatment 
and inhalation as on the day previous ; the epiglottis 
and arytenoid cartilages were touched with nitric acid, 
5ss. to f§j. By the 13th every function was in order. 
Recovery complete. 

Case VI. Hulda H., set. 5. Second day of disease, 
Aug. 24, condition as follows : pulse 140 ; resp. 32 ; 
no albumen in urine; sleep disturbed; voice hoarse; 
considerable dysphagia ; cough frequent and hoarse ; 
lymphatics much swollen on both sides and painful upon 
pressure ; both tonsils, the uvula, and a portion of the 
arches much swollen, and covered with thick leathery 
pseudo-membrane; epiglottis swollen, considerable white- 
gray deposit on its upper surface, receding on the right 
side toward the ary teno-epiglottic ligament. Treatment : 
internally, potass, chlor. oij to fgvj, a tablespoonful 
every second hour ; locally, cauterization with acid 
chrom. 5\j to f§j ; by inhalation, alum 5ss. to f§vj, 
two ounces every second hour. On the 28th the con- 
dition had become as follows : pulse 120 ; resp. 28 ; 
much albumen in urine ; lymphatic swellings less pain- 



INHALATIONS ARE APPLICABLE. 127 

ful on pressure ; right tonsil almost entirely clean, left? 
still covered ; epiglottis clean. Treatment : internally, 
liq. ferri sesquichl. 5 drops every third hour ; locally, 
touching with arg. nit. 3j to f.5j ; by inhalation, alum 
as before. By the 30th, convalescence was established, 
and the case went on to complete recovery. 

Case VII. August M., set. 10, living in a dirty un- 
healthy cellar ; rather delicate, but had always been 
well. Aug. 26, took cold running about the streets, 
felt unwell, with loss of appetite. Dysphagia began 
early on 27th. Aug. 30, condition as follows : pulse 
140 ; resp. 36 ; no albumen in urine ; sleep restless ; 
voice hoarse ; considerable dysphagia, with pain in the 
right ear on eating ; lymphatics on both sides swollen 
and painful to pressure ; the uvula lengthened and thick- 
ened, and as if covered with kid ; pseudo-membrane 
upon both tonsils and palatine arches, and sharply de- 
fined from the sound tissue; epiglottis much swollen, 
and on the right side of its free border, covered with 
pseudo-membrane ; vocal cords normal ; nostrils much 
inflamed. Treatment: internally, potass, chlor. 5ij to 
f§vj, a tablespoonful every two hours; locally, cauter- 
ization with chromic acid 5\j to fSj. Inhalations of 
alum 5ss. to fgvj, 1J-2 oz. every two hours. On the 
2d of September, 5 drops of liq. ferri. sesquichlor. every 
3 hours was substituted for the chlorate of potassa. 
Recovery prompt. 

Case VIII. Helen M., set. 8, sister of Case VII. 
Dec. 1, condition as follows: pulse 132; resp. normal; 
sleep uneasy ; considerable dysphagia ; lymphatics on 
both sides swollen, and painful on pressure ; tonsils and 
arches covered with pseudo-membrane ; epiglottis some- 



128 DISEASES TO WHICH NEBULIZED 

what inflamed. Treatment : internally, potass, chlor. ; 
inhalation ; locally, chromic acid. Complete recovery. 

Case IX. Louise M., set. 3J, sister of Nos. VII and 
VIII. Tonsils not inflamed, but swollen, and upon 
them isolated spots of pseudo-membrane. The spots 
were touched with chromic acid ; a solution of alum 
was inhaled, and the next day all the local symptoms 
vanished. No general treatment required in this case. 

Case X. Mary P., get. 15. Jan. 25, fourth day of 
the disease, condition as follows : pulse 128 ; resp. 
38 ; urine slightly albuminous ; sleep poor ; voice hoarse ; 
severe dysphagia ; moderate cough ; lymphatics on both 
sides swollen ; on the right tonsil, and right soft palate, 
white matters, but as in this case nitrate of silver had 
been applied locally the day before, it is impossible to 
determine whether the appearance denoted diphtheritic 
exudation, or the escharotic effect of the nitrate of sil- 
ver ; larynx perfectly clear, not even injected. This 
case was treated with chlorate of potassa internally, cau- 
terization with chromic acid after the exudation had 
spread somewhat, and inhalation of a solution of alum. 
Recovery was prompt in a few days. 

Case XI. Bertha E., set. 4. Dec. 24, appeared pale, 
lost appetite, and complained of pain in swallowing. 
Examination showed pseudo-membrane on both tonsils, 
on velum, and on posterior wall of pharynx. Treatment 
was immediately instituted by local cauterization with 
chromic acid, and the administration of chlorate of 
potassa internally. Dec. 28, condition as follows : pulse 
104 ; resp. 24 ; urine contained considerable urates, no 
albumen ; sleep good ; voice somewhat hoarse ; trifling 
dysphagia ; trifling cough ; lymphatics very much swollen 
and painful ; posterior wall of pharynx, uvula, both 



INHALATIONS ARE APPLICABLE. 129 

arches, and tonsils, fully covered with pseudo-mem- 
brane ; larynx very much inflamed, as also epiglottis 
and false vocal cords ; true cords free. Treatment : in- 
ternally, liq. ferri sesquichlor. 5 drops every two hours ; 
locally, cauterization with chromic acid ; by inhalation, 
alum. Condition gradually improved, and on Jan. 1st, 
1864, pulse 100, resp. 16 ; lymphatics still swollen and 
painful. Treatment : internally, decoct, cinch. (5ij to 
fgiv), acid hydrochl. f5ss., and Tokay wine ; inhalations 
of chlorate of potassa 5j to f^vij. Jan. 2d, pulse 140 ; 
resp. 28 and stridulous ; voice very hoarse ; pseudo- 
membrane on lower surface of epiglottis, and on aryt- 
enoid cartilages. Treatment : internally, liq. ferri ses- 
quichl. and Tokay wine; cauterization with chromic acid, 
3j to fgj. Three paroxysms of marked dyspnoea at 
night. Jan. 3d, pulse 136 ; resp. 24, and freer ; some 
albumen in urine, and a good deal of urates ; cough in- 
creased but dry ; lymphatics still swollen ; local ap- 
pearances unchanged. Treatment : internally, potass, 
nit., potass, bicarb, aa 5j, to f§iv of Tokay wine ; cau- 
terization as before, followed by an hour's vomiting of 
slime. Coughed up in the night thick yellow-reddish 
membranes, tinged with blood on their internal sur- 
faces, and which from their form must have come from 
the trachea. Jan. 4th, pseudo-membrane also upon the 
false vocal cords. Treatment: internally, liq. ferri 
sesquichl. ; by inhalation, potass, chlor. A short par- 
oxysm of dyspnoea at night. Jan. 5th and 6th, pulse 135 ; 
resp. 32 : aphonia ; pharynx almost clean ; pseudo- 
membrane only on epiglottis. Treatment : the same. 
Similar dyspnoea at night. Jan. 9th, pulse 160 ; resp. 
40; marked stridor; urine scanty, more albumen; 
cough severe and whistling ; vocal cords covered with 



130 DISEASES TO WHICH NEBULIZED 

diphtheritic deposits ; pharynx entirely clear ; circum- 
scribed pneumonia on right side with rusty sputa. 
Treatment : the same. Jan. 10th, pulse 130 ; resp. 32 ; 
no stridor ; urine containing much albumen, filling half 
the test-tube. Treatment : internally, sodse nit., carb. 
nit. aa 5j to f§iv; otherwise the same. Very little 
rusty sputa. After two days further, improvement 
began and continued to complete recovery. 

Case XII. C. D., laborer, set. 46. June 7th, 1864, 
condition as follows : pale, feeble, and emaciated ; diph- 
theritic chancre on foreskin and glans penis, both of 
which are half destroyed ; diphtheritic pharyno-laryn- 
gitis. Posterior wall of pharynx, soft palate, uvula, 
both arches, covered with membrane so adherent that 
an attempt to remove it with the forceps produced 
hemorrhage ; the middle portion of both lips in great 
extent partly covered with diphtheritic deposit, partly 
with adherent sanguinolent effusion ; lymphatics at 
angle of lower jaw, both sides, much swollen. Epiglottis 
swollen to three or four times its natural thickness, 
covered on both faces with thick pseudo-membrane ; so 
also, but more thinly, the false vocal cords and the aryt- 
eno-epiglottic ligaments. True vocal cords reddened, 
a yellowish-white exudation at the lower attachment of 
the left cord. No albumen in urine ; voice hoarse ; a 
good deal of hoarse cough ; temperature 38.4 R. ; pulse 
80, resp. 24. Treatment : locally, acid chr. 5ss. to fgj. 
aq. dest., detaching a piece of leathery membrane an 
inch in length and almost the same size in breadth ; in- 
halations of potass, chlor. gr. x to f5ij, by the steam 
nebulizer. Internally, decoct, cinch. (5ij to fSiij), with 
vin. rubri. foiij, seth. spts. nit. gtt. x, acid phosp. 5j, 
elseos. citri f§ss. ; a tablespoonful every two hours. 



INHALATIONS ARE APPLICABLE. 131 

Spirits of camphor locally to the chancres. July 16th, 
recovered. 

Case XIII. Marie J., set. 13. Taken with diph- 
theria on Christmas eve, 1863 ; diphtheritic membrane 
on both tonsils, and the right posterior palatine arch, 
from which a small diphtheritic ulceration reached to 
the anterior border of the epiglottis. The parts were 
touched twice a day with chromic acid 5ij to foj, and 
on the fourteenth day, had improved enough to pass 
from observation. January 19th, she returned under 
treatment for difficulty in swallowing solids, and altera- 
tion in voice ; she remained under treatment until 
March 17th, and eventually recovered completely. 

Case XIV. Hugo L., set. 9, had some exudation on 
the tonsils, and some specks on the uvula. These were 
touched with chlorate of potassa in glycerine, and sul- 
phate of copper was given as an emetic. Suffocation 
set in, and tracheotomy was thought necessary. Laryn- 
goscopy revealed trifling exudation upon the vocal cords, 
and inflammation of the posterior wall of the larynx, 
but there was no mechanical obstruction to respiration. 
Inhalation of the watery vapor from emollient decoc- 
tions were employed, and subsequently inhalations of 
oxygen gas, with good results; and eventually the 
child recovered. 

Case XV. Mrs. W., set. 23, had some alteration of 
voice following an attack of diphtheria. This was 
found to depend on a small warty excrescence situated 
near the attachment of the right vocal cord. The 
cords were somewhat thickened, and the general mucous 
membrane injected. The topical treatment consisted 
in touching the excrescence with iodine in glycerine, 
tannin, and nitrate of silver, and inhalations of a solu- 



132 DISEASES TO WHICH NEBULIZED 

tion of tannin, and later of ol. pini pumelion. The ex- 
crescence diminished, and the voice regained its timbre, 
but at last accounts was still incompetent for the pur- 
poses of vocal music. 

The three following cases terminated fatally. In 
none of them was the local treatment instituted until 
after the diphtheritic process had already extended 
more or less into the larynx, or at least over the upper 
surface of the epiglottis. 

Case XVI. F. J., boy, set. 8|. Christmas, 1862, 
was attacked with tonsillitis, which was cured by local 
treatment in fourteen days. February 26th following, 
was attacked with severe coryza, with parotitis, swell- 
ing of the lymphatics, and severe fever. Deglutition 
becoming painful, an examination of the fauces showed 
the velum swollen, dark-colored, and covered here and 
there with grayish spots. The pseudo-membrane soon 
extended towards the posterior pharyngeal wall, and from 
the attendant dyspnoea and croupal cough sound, seemed 
to have penetrated into the larynx. An emetic of anti- 
mony and ipecac' afforded relief, with the expulsion of a 
fragment of membrane ; but the disease soon assumed a 
typhic character, when acid hydrochl. (5ss. to f 5x) was 
administered inwardly, and a topical application of the 
muriatic acid was made by the pencil. 

March 1st, the condition was as follows : pulse, 176, 
small and weak ; respiration, 60, inspiration rough and 
rattling, expiration shorter and less stridulous ; coun- 
tenance pale ; lips, clear red, with some spots less 
red ; belly, tumid ; parotids and lymphatics, swollen 
and painful; mucous rales over the chest ; velum, ton- 
sils, arches, posterior pharyngeal wall covered with 






INHALATIONS ARE APPLICABLE. 133 

adherent exudation, exposing bloody spots when re- 
moved ; epiglottis swollen to the size of the middle finger, 
leaving but a small slit sideways for the passage of air ; 
in the middle of its anterior border, an excoriated spot 
reaching to the lower surface, partly bloody and partly 
covered with gray-white exudation ; a great deal of 
albumen in urine. Treatment : internally, Liq. ferri 
sesquichl., 3j to f§x ; locally, cauterization with chro- 
mic acid, the retching produced by which ejected some 
slimy whitish-gray masses, tinged with blood ; by in- 
halation, argent, nitr., gr. ss. to f5j, an ounce every 
hour through Bergson's apparatus. In the night of 
March 1-2, there was severe dyspnoea, with marked 
stridor attendant upon both acts of respiration ; pulse, 
206 ; respiration, 30 ; strong cardiac impulse ; ex- 
tremities cool ; intelligence disturbed ; a great deal of 
albumen in urine. Now, half a drachm of unguent, hy- 
drarg. cinereum was rubbed in every two hours. In the 
evening, the dyspnoea had somewhat reduced, and the 
child was more comfortable ; skin dry, but not hot ; 
epiglottis free from membrane, but more swollen ; from 
between the epiglottis and posterior wall of phar- 
ynx, a loose piece of membrane was removed by the 
finger. An attempt to induce retching by mechanical 
irritation, so as to expel some more of the membrane, 
failed, a little thick slime only being expectorated. At 
eleven clock at night, the difficulty of respiration 
became much increased ; pulse rose to 212, and great 
weakness ensued; and at two o'clock the patient died 
comatose. 

Case XVII. Fritz M., set. 8, whose two sisters had 
contracted diphtheria a few days previous, was attacked 
with the disease, the local process destroying the ton- 

12 



134 DISEASES TO WHICH NEBULIZED 

sils by ulceration, and attacking the glotto-epiglottic liga- 
ment. The swollen epiglottis was attacked on its laryn- 
geal surface by the diphtheritic process, as were also 
the ary-epiglottic ligaments. The disease progressed, 
and the child died. The treatment consisted in the ad- 
ministration of chlorate of potassa ; cauterization with 
chromic acid ; and the inhalation at first of tannin, and 
subsequently of sesquichloride of iron, at which time 
the same remedy was substituted internally also. 

Case XVIII. Anna M., set. 14, with diphtheritic 
exudation upon pharynx, laryngeal face of epiglottis, 
and arytenoid cartilages ; urine loaded with albumen. 
Improvement. On the twenty-second day, inflamma- 
tion (diphtheritic ?) of the stomach ; urine scanty, with 
a good deal of albumen ; paralysis of velum, and later 
of oesophagus ; nourishment by the stomach-tube ; hy- 
drothorax ; hydropericardium. Death on thirty-third 
day. 

This case was treated at first with sesquichloride of 
iron internally ; cauterization with nitrate of silver and 
chromic acid ; and inhalation* of a solution of tannin, 
to which after a few days conium was added, about a 
drop and a half to the ounce, while sulphate of quinine 
was added to the iron treatment. Various other treat- 
ment, such as the administration of digitalis, nitrate 
of potassa, &c, and the inunction of a mercurial oint- 
ment, was employed to meet certain indications. 

Lewin mentions that the local application of the 
chromic acid in all these cases, produced retching, often 
violent and sometimes continuing for some time. It is 
probable that this mechanical effect contributed towards 
a good result. The inhalations seem to have answered 



INHALATIONS ARE APPLICABLE. 135 

a good purpose ; probably by keeping up a supply of 
watery matter, and thus assisting in the expectoration 
of the exudation before its coagulation into membrane. 
At the same time it will be perceived that systemic med- 
ication was not neglected, although much stress cannot 
be laid on the chlorate of potassa, which was the remedy 
most frequently employed internally, for in this country 
its internal administration has not proved adequate 
to resist the systemic poisoning, or even produce much 
effect upon the local trouble. 

The cases are worth recording, on account of the re- 
markable result — a cure in fifteen cases out of eighteen 
— the three fatal cases being all of them more unfavora- 
ble from the outset than the others, and farther ad- 
vanced in progress before the institution of treatment, 
leaving the inference that even these cases might have 
terminated differently had they been placed under this 
routine earlier. 

I hardly think the cases of diphtheria, as met with in 
this country, would be amenable to the same treatment, 
unless at the same time the system were continuously 
supported by ordinary stimulants. 

M. Kuchenmeister, of Dresden, has published a 
case of diphtheritic pharyngo-laryngitis in a child of 
three years and a half old, treated with inhalations of 
lime-water with complete success (Brit. $- For. Med-Chir. 
Rev., July 1865). 

Dr. Da Costa, of Philadelphia (op. cit., p. 32), has 
watched, in two cases of diphtheria, the action of lime- 
water on the visible deposits. 

In the first case, that of a lady, seen in consultation 



136 DISEASES TO WHICH NEBULIZED 

with her physician on the fifth day of her confinement, 
the deposit covered the roof of the mouth, the half 
arches, and part of the wall of the pharynx. There was 
also — and indeed the progress of the case placed the 
matter beyond doubt — reason to believe that nasal diph- 
theria existed. She was taking chloride of iron, full 
nourishment, and stimulants. A stream of pulverized 
lime-water, about eight times stronger than that offici- 
nal in our Pharmacopoeia — the liquor calcis saccharatus 
of the British Pharmacopoeia — was directed upon the 
affected part by means of an excellent hand-ball atomi- 
zer for three or four minutes at a time. The treatment 
was carried on every few hours, but no perceptible in- 
fluence on the membrane could be detected. The appli- 
cation was cleansing and very grateful, particularly so 
when thrown up the nostrils. The case terminated 
fatally, the membranes in the mouth remaining in a very 
thick layer. 

The second case was that of a gentleman thirty-five 
years of age. Here there was no nasal diphtheria, nor 
were the constitutional symptoms by any means so 
grave ; and after the disappearance of the membranes, 
which took place in about nine days, convalescence was 
rapid. As local treatment, early in the affection, a 
strong solution of sulphate of copper was employed. 
But both at the time, and afterwards, Dr. Da Costa 
made use of atomized solutions of lime, in the same 
manner as in the preceding case, and not hot. The 
remedy was again very grateful and cleansing ; yet, 
though the same spot in the left half arch was repeat- 
edly selected on which to throw the solution, no percep- 
tible effect in thinning the deposit could be noticed from 
its influence. 



INHALATIONS ARE APPLICABLE. 137 

It will be remembered that inhalation of lime-water 
has been proposed in cases of diphtheria, on account of 
its supposed solvent powers upon the diphtheritic mem- 
brane in situ. 

Dr. James Collins, of this city, has furnished me 
with the following notes of a case of diphtheria, in 
which lime-water inhalations were administered, under 
his treatment : 

Wm. M , set. 3. When called to this little 

patient, September 24, 1866, I found him pallid, strug- 
gling for breath, with cold extremities, pulse 120 and 
feeble, and marked diphtheritic deposit lining the fauces 
and covering the tonsils. According to the mother's 
statement, the child had been " sickish-like" for ten days, 
but not sick enough to cause her to send for the doc- 
tor. I removed several large flakes of diphtheritic 
membrane with the finger very readily, gave injections 
of quinia and beef tea, ordered wine and water, and ad- 
ministered lime-water inhalations. The effect of the lo- 
cal treatment seemed to be quite marked. The difficulty 
of breathing was greatly relieved ; the pulse became less 
frequent and fuller ; the skin became warmer, and for a 
time the child seemed to be relieved. During the night 
he again became worse and died. 

(Edema of the Glottis. 

Trousseau (Clinique Medicate de V Hotel Dieu, Paris, 
1861, p. 475) records a severe case of oedema of the 
glottis promptly relieved by inhalations of tannin. A 
woman, set. 21, who had recovered from puerperal per- 
itonitis six weeks previously, was admitted into the 
hospital with great pain in the throat, swollen tonsils, 

12* 



138 DISEASES TO WHICH NEBULIZED 

and difficulty in swallowing. The angina, already of ten 
days' duration, increased rapidly in severity, at times 
impeding respiration to such an extent as to threaten 
life. Inspiration was accompanied by laryngotracheal 
r&les, although respiration was free, and the voice re- 
tained its natural tone. The countenance of the patient 
was like that of one threatened with asphyxia ; the pulse 
extremely small ; the submaxillary region tumid and 
painful. The pharyngeal mucous membrane was very 
much inflamed, and examination with the finger re- 
vealed an oedematous swelling of the epiglottis and the 
aryteno-epiglottic folds. The diagnosis was, of course, 
oedema of the glottis. 

Inhalations of a strong solution of tannin from the 
apparatus of Mathieu were at once instituted and re- 
peated hourly ; under the influence of which, the attack 
moderated, and on the following day there was marked 
improvement, — but a single suffocative paroxysm ensu- 
ing, and that of less intensity, — with greater freedom of 
respiration, and disappearance of the rales. The swelling 
of the epiglottis and of the aryteno-epiglottic folds had 
markedly diminished likewise. The respiration soon 
became normal, and only a single suffocative paroxysm 
occurred in twenty-four hours ; and in four days the 
patient left the hospital advanced in convalescence. 

Trousseau also reported to the Academy of Medicine 
another case of oedema of the glottis likewise cured by 
inhalations of a solution of tannin. 

I have myself treated two cases of oedema of the 
larynx. One w r as the case of a lady in this city, who 
was carried out insensible from the upper story of a 
house on fire, in which very combustible materials, as 
soaps, oils, &c, were burning. The dense hot smoke 



INHALATIONS ARE- APPLICABLE. 139 

from these substances had been inhaled, and produced an 
intense laryngitis with complete aphonia. I was called 
to the patient a few hours after the occurrence, and 
found her exhausted, in great distress from dyspnoea, 
and threatened with death from suffocation. A solu- 
tion of the watery extract of opium was immediately 
procured, and an ounce administered warm by inhala- 
tion, with relief to the suffering, and, to some extent, 
to the dyspnoetic paroxysms. The inhalations were 
repeated every half hour, for four or five times, until 
respiration had become markedly relieved, when they 
were given in a more diluted form every two hours. I 
paid the patient five visits within seven hours, and at 
each visit administered the inhalations myself, so as to 
insure the proper administration of some of them. The 
expressions of gratitude for relief were such as to leave 
no doubt as to their good result, and the patient would 
not have parted with the apparatus under any con- 
sideration. The opium inhalations were continued 
three or four times a day for a week, when the acute 
symptoms of laryngitis having subsided, tannin was 
substituted, with the result of return of voice. 

The second case, that of a widow in this city, was 
sent to me by my friend and colaborer, Dr. D. D. 
Richardson. The laryngitis in this instance was 
very painful, and complete aphonia had existed for five 
days. There was very great dyspnoea, so that the 
patient gasped for breath as she entered my apartment. 
She said that, several times, while coming to visit me, 
she felt as though she would not be able to breathe any 
longer. I made a laryngoscopic examination, and 
found the aryteno-epiglottic folds very much swollen 
and inflamed, and the false vocal cords so oedematous, 



140 DISEASES TO WHICH NEBULIZED 

as to entirely cut off a view of the true cords. This 
appearance was recognized by Dr. Henry V. Gray, of 
Petersburg, Va., who happened to be in my office at 
the moment, a gentleman who was at that time, him- 
self familiar to some extent with the use of the laryn- 
goscope. In Order to relieve the intense distress of 
the patient, I placed her before an apparatus from 
which a patient but a few minutes before had been in- 
haling a warm solution containing of laudanum f 5j to 
f Sj ; and set the pump going, while I was getting out 
my scarificator, with the intention of scarifying the swol- 
len structures. She could not have taken above half a 
dozen inspirations, when she heaved a long sigh of 
relief, followed by a prolonged oh ! and, continuing the 
inhalation, in a few minutes the dyspnoea had vanished, 
and the voice had returned, rendering scarification un- 
necessary ; for on a second laryngoscopic examination, 
the tumefaction was so much reduced as to forbid sur- 
gical interference. The result was unanticipated by 
myself, and Dr. Gray exclaimed, " Why, Doctor, that 
is magic !" 

A dose of sulphate of magnesia was ordered for the 
patient, and she was directed to use embrocations of 
the oil of turpentine externally for a few days. The 
trouble rapidly subsided after the single inhalation, so 
that its repetition was not requisite. 

Stricture of the Glottis. 

Dr. Semeleder, of Vienna, relates (Wochenblatt der 
Zeitschrift der K. K. Gresellsch. d. Aerzte in Wien., 
No. 1, 1864, Lewin, op. cit., p. 289) a case of stenosis 
of the larynx, supervening during the healing of an 



INHALATIONS ARE APPLICABLE. 141 

incised wound, completely relieved by inhalations of a 
solution of alum. 

A woman, set. 46, endeavoring to commit suicide, 
cut her throat, with a razor, about the position of the 
upper border of the thyroid cartilage. The larynx 
w r as opened close under the epiglottis, and thence the 
wound communicated directly with the pharynx. The 
voice was low and difficult, swallowing painful, and on 
an attempt to drink, some drops would flow down be- 
tween the arytenoids upon the vocal cords, and thence 
out of the wound. 

On the fourth day, an elastic catheter, and over this 
a double canula of hard rubber, was placed within the 
glottis through the wound, with relief to respiration 
and expectoration. After the condition of the patient 
had gradually improved to a remarkable degree, sud- 
denly, on the forty-ninth day, she was seized with diffi- 
culty of breathing, following exposure to cold, ac- 
companied with swelling of the vocal cords, true and 
false, and the production of a stenosis of the larynx. 
To relieve this, the inhalation of a nebulized solution 
of alum in water was employed, beginning with 5j to 
Sbj of water, and later increased to 5ij, with the addi- 
tion of a few drops of.tr. opii, in order to secure the 
astringent effect of the inhalations. 

The patient inhaled, once, daily, six to eight minutes, 
the canula being closed. She improved so much that 
the swelling and congestion of the whole laryngeal 
structures, as well as the epiglottis, gradually became 
reduced. Immediately after each inhalation, the voice 
was much louder than it had been before. After three 
weeks of these inhalations, the glottis had again be- 
come so movable, that the canula was withdrawn from 



142 DISEASES TO WHICH NEBULIZED 

the wound. The patient breathed freely without the 
canula, and the voice gradually improved. 

Aphonia. 

Dr. Johann Schnitzler reports (op. cit.) a case of 
complete aphonia cured by inhalations of alum. For 
two years the patient had been subject to recurrent 
hoarseness, until, some six or eight months before treat- 
ment by inhalation, the voice suddenly left, and the 
aphonia remained constant. The laryngoscope showed 
marked swelling of the vocal cords, and of the mucous 
membrane of the larynx generally. Nothing abnormal 
was detected in the lungs. This physical condition was 
confirmed by Semeleder. Inhalations of a solution of 
alum were instituted, and on the second day the voice 
was louder ; and in eight or nine days the patient had 
recovered a pretty good voice, though hoarse, which be- 
came clearer and louder every day. The gradual dim- 
inution of the catarrhal swelling of the vocal cords 
was watched with the laryngoscope. 

WaldenburGt (op. cit., p. 332) reports the loss of 
voice in a case of laryngitis and tuberculosis, in which 
the aphonia was improved under the inhalation of a 
solution of common salt, gr. ij to the ounce. 

Fieber (op. cit., p. 119) reports a case of laryngo- 
tracheal catarrh, with almost complete aphonia, in which 
the voice soon returned, under the inhalation of a solu- 
tion of tr. opii gtt. vj, zinci. sulph. grs. vj, to the ounce 
of water. 

In aphonia from paralysis of the vocal cords, now 
usually treated by the local application of electricity, 
Dr. Klimbacher employed with success in addition (Fie- 
ber, op. cit,, p. 119) inhalations of a solution of tannin. 






INHALATIONS ARE APPLICABLE. 143 

LEWiNalso employed in addition to the Faradization, 
inhalation of a solution of the sesquichloride of iron, 
with good result in a case of pharyngo-laryngitis, with 
occasional hysterical aphonia. 

Siegle (op. cit., p. 70) employed inhalation of a 
strong solution of alum for three days, with partial 
return of the voice, in a case of hysterical aphonia, of 
several years' duration, the cure being subsequently 
rendered permanent by local Faradization. 

Siegle (pp. cit., p. 71) also relates a case of rheumatic 
aphonia in a student, whose voice improved day by day 
under several inhalations daily of hot vapor of water, 
so as to leave nothing more to be desired on the eighth 
day ; and he mentions a similar case reported by Lewin, 
which had not improved under Faradization of three or 
four weeks' continuance, and in which prompt and per- 
manent relief followed the hypodermic use of strychnia 
in doses gradually increased to half a grain. 

Where aphonia is a result of acute or chronic inflam- 
mation of the vocal cords, with swelling or iifduration 
of their structures, the remedies applicable to the local 
condition of the parts will cure the aphonia. 

I treated a case of aphonia of several months' dura- 
tion, the past winter, in a young lady who, after failure 
of the ordinary methods, had been treated by inhala- 
tions of tannin daily for ten weeks, without result, and 
who was sent to me as a case of nervous aphonia. I 
tried for a day or two, inhalations of a watery solution 
of iodine, from Mathieu's (cutler) apparatus on the Sales- 
Girons principle, with a slight improvement of the 
voice, but seeing on examination with the laryngoscope, 
that the aphonia was not nervous, but due to chronic 
inflammation of the vocal cords, with thickening, I re- 



144 DISEASES TO WHICH NEBULIZED 

sorted to local applications of a strong solution of nitrate 
of silver, applied by the probang, and this being in- 
effectual, after two or three trials, I applied a solution 
of the corrosive sublimate, 60 grains to the ounce, with 
restoration of the voice, which, under the continuance 
of the treatment, gradually improved in timbre, and 
with final relief from all the nervous symptoms which 
had ensued under fears of consumption, and the mental 
dread of an incurable affection. ♦ 

In one case of aphonia from the inhalation of hot 
smoke and flame during exposure in a house on fire, after 
the more acute symptoms of laryngitis had subsided, I 
employed inhalations of tannin for the laryngeal trou- 
ble, and during their employment, the patient recovered 
her voice. 

In several other cases contracted under the same cir- 
cumstances, which, under my own observation, were 
treated by Dr. W. W. Keen of this city, the same re- 
sult followed the same treatment. In these cases, how- 
ever, the relief of the local trouble causing the loss of 
voice in the first instance, naturally relieved the aphonia. 

I have in this way relieved several incidental apho- 
nias dependent on laryngitis, bronchitis, &c. 

Whooping- Cough. 

Dr. Wedemann, of Jena, assistant in the clinic of 
Prof. Gerhardt (quoted by Fieber, Siegle, and Lewin, 
op. cit. p. 278-85), reports a number of cases treated 
by inhalations of nebulized medicaments, and among 
them a case of whooping-cough in a child seven years 
of age, in whom the intensity of the spasms of cough 
began to diminish after the very first inhalation of a 



INHALATIONS ARE APPLICABLE. 145 

solution of sesquichloride of iron, gtt. iij to the ounce 
(Wedemann, op. cit. p. 42). 

Fieber (op. cit. p. 116) reports the case of a child four 
years of age, in whom the paroxysms threatened suffo- 
cation, and in which the disproportion between the ob- 
jective symptoms and the subjective phenomena lead- 
ing him to consider the affection a disease of the par 
vagum, rather than of the minute bronchi and air cells," 
he resolved to employ inhalations of the following mix- 
ture : Ext. hyoscyami sem. alcoh. gr. vj, ol. olivse, 
f Sj, pulv. gummi arab. §ss., aq. font. Ifoij. After 
eight days' use, the disease had become so mild that 
further attendance was unnecessary. The emulsion was 
very well nebulized. Treatment began April 23d, 380 
inhalations (inspirations) readily taken ; no cough, nar- 
cotic effect produced. 24th, same treatment; four spells 
at night, no blood in sputa; next night two paroxysms 
of cough. The cough worse in daytime while the child 
is moving about. 25th, 380 inhalations. 26th, one spell 
during the night, less intense than before ; 380 inhala- 
tions. 27th, child slept all night, 380 inhalations. This 
treatment was kept up until the 30th, with cessation of 
all the disagreeable symptoms. 

Siegle (op. cit. p. 73) reports the cases of two sisters, 
aged respectively three and five years, in whom the dis- 
ease Jiad lasted for five days. He employed inhalations of 
a solution of alum, a drachm to six ounces of water, twice 
daily, ten minutes at a time. By the night of the very 
first day, the paroxysms had abated in violence, and 
the cases were completely cured ; the younger on the 
eighth day of treatment, and the other a few days later. 

Dr. Rohn, of Hanau ( Wien. Med. Wochenschrift, xvi, 
52, 53, 1866), was led to the employment of inhalations 

13 



146 DISEASES TO WHICH NEBULIZED 

of a solution of nitrate of silver in whooping-cough, in 
consequence of the result of several laryngoscopic ex- 
aminations of adults and larger children, while suffering 
with this affection. He found the mucous membrane, 
covering the anterior wall of the lower portion of the 
laryngeal cavity and the commencement of the trachea, 
hyperaemic in a marked degree, the vocal cords spark- 
ling white and in marked contrast to the intense red of 
the subglottic region. He therefore considers that the 
lower laryngeal space, and the commencement of the 
trachea and the upper portion of the trachea, is the seat 
of catarrhal inflammation during the spasmodic stage of 
whooping-cough; and he is confirmed in this view by 
the uniform statements of adults and larger children, 
that a peculiar severe irrita-tion about the upper part of 
the windpipe precedes the spasm of cough which it ex- 
cites. Dr. Rohn inquires whether the existence of the 
catarrh at this point is not the true cause of the peculiar 
paroxysms of cough ; and if the irritation of the in- 
ferior laryngeal nerve, which is composed of sensory 
fibres, will produce the same result with irritation of 
the internal filaments of the superior laryngeal nerve. 
Concluding, therefore, that the commencement of the 
spasmodic affection might also be due to a catarrhal 
condition of the mucous membrane of the central and 
smaller bronchi, he resorted to the therapeutical effect of 
inhalations, in order to reduce the inflammatory process 
by a local caustic action. He has convinced himself 
that such treatment resulted favorably in the cases of 
six children over four years of age, and in two grown 
persons. The medicament was a solution of the nitrate 
of silver, gr. J-l to the ounce of distilled water, ac- 
cording to the age of the patient, and the severity of 



INHALATIONS ARE APPLICABLE. 147 

the affection. About half an ounce of the solution was 
inhaled once daily. All these cases were of from three 
to five weeks' duration, and either in the beginning of 
the convulsive stage, or at its maximum. Dr. Rohn 
states that after the first two, and at the furthest, after 
the first three inhalations, the cough became markedly 
diminished in violence and duration, and in all of them 
with an immediate abatement of the vomiting ; that 
after the fourth and sixth inhalation, the general char- 
acteristic whooping-cough symptoms disappeared ; leav- 
ing behind, at the most, but a slight simple catarrh. A 
still further experience convinces the investigator that at 
least with children over four years of age, who can be 
very well made to take the inhalations, other febrile 
complications of the respiratory organs do not contra- 
indicate the inhalatory treatment. [Schmidt's Jahr- 
biicher, Nov. 1866, p. 57.) 

Further on this subject see Schmidt's Jahrbiicher, 
July, 1866, p. 62, on the treatment of whooping-cough 
by inhalations of nebulized solutions of tannin, by 
vapors of turpentine, and, p. 63, by air breathed in 
the apartments for purifying illuminating gas. 

Acute or Catarrhal Bronchitis. 

To be treated on the same principles as catarrhal 
laryngitis, only the inhalations should be increased in 
number, in strength of solution, and in duration ; while 
the inspirations are to be made more slowly and deeply, 
so as to draw the fluid particles into the bronchial 
tubes. 

Nebulized warm water often affords considerable re- 
lief and increases the facility of expectoration. In the 



148 DISEASES TO WHICH NEBULIZED 

forming stage of acute bronchitis, sal ammoniac is an 
excellent addition to the warm water. 

For the relief of pain, narcotic and mucilaginous 
solutions should be employed ; to reduce secretion, as- 
tringents. 

In putrid bronchorrhoea, in addition to astringent 
remedies, the balsams serve a useful purpose. Walden- 
burg and Lewin recommend particularly the tar-water 
in these cases, when there is no fever. Siegle recom- 
mends tannin, on account of its antiseptic qualities. 
Others recommend alum. Fieber speaks highly of the 
sulphate of zinc under these circumstances. 

Chronic Bronchitis. 

In this affection particularly, inhalations have been 
highly recommended. In the ordinary form of the 
disease weak solutions of tannin, of alum, and of iron, 
appear to be the favorite remedies. Wedemann recom- 
mends very highly, a solution of tannin; two grains to 
the ounce, with the addition of one-twentieth of a grain 
of morphia. Siegle prefers the action of *the tincture 
of the chloride of iron. 

Da Costa (op. cit. p. 34) narrates a severe case cured 
mainly by inhalations of alum, eight grains to the 
ounce, with the addition of six drops of the fluid extract 
of conium, the alum being gradually increased to the 
proportion of twenty grains to the ounce. 

Beigel (p. 121) details a case in which inhalations, 
night and morning, of a solution containing two grains 
of alum and ten minims of laudanum to the ounce of 
distilled water, proved successful after the failure of 
many other remedies. He also details a severe case 
(p. 124) which he relieved by inhalations of tannin grs. 



INHALATIONS ARE APPLICABLE. 149 

iij, ext. hyoscyami. grs. ij, aq. dest. f§j, night and morn- 
ing, subsequently changed, on account of the taste, to 
sulphate of iron, four grains to the ounce; and also a 
case of chronic bronchitis, occurring after small-pox, 
which succumbed to inhalations three times a day, of 
alum, one grain to the ounce, with the addition of ten 
minims of laudanum. 

Fieber reports a case, of the variety simulating 
consumption, of twenty-five years' standing, which im- 
proved in a marked degree under the inhalation of a 
solution of sulphate of zinc, five grains to the ounce. 
In the dry variety of the disease, Fieber recommends 
his oleaginous mixture. 

In this dry variety, the inhalation of warm water will 
often subserve a useful purpose by supplying moisture ; 
and if it does not facilitate expectoration sufficiently, 
a little common salt, sal ammoniac, or chlorate or car- 
bonate of potassa, may be dissolved in it. Inhalations 
of iodized water are often recommended in this affec- 
tion, as are also weak solutions of the nitrate of silver. 

Good effects occasionally ensue from the liq. iodinii 
compositus, ten to forty drops to the ounce of water, 
two and three times a day. If there coexist pain, of 
course the narcotics and sedatives may be added to the 
inhalation, but preferably in minute quantity. In- 
halations, however, should be accompanied by external 
revulsion, and attention to diet, social and domestic 
habits, &c. 

Ecemoptysis. 

The principal articles employed to restrain hemor- 
rhages from the air-passages have been cold water, ses- 
quichloride of iron, subsulphate of iron, tannin, alum, 
and ergot. 



150 DISEASES TO WHICH NEBULIZED 

Cold water was first recommended by Fieber (Allg. 
Wien. Med. Zeit., 1862, No. 16), who says that where 
it can be borne, the inhalation of cold water at a tem- 
perature of from 8° to 10° R., suffices in slight cases of 
haemoptysis, and in cases of bloody sputa. 

The solution of the sesquichloride of iron, is the rem- 
edy most frequently resorted to in haemoptysis, on ac- 
count of its well-known haemostatic agency, coagulating 
the albumen of the blood into an insoluble clot, and thus 
preventing further escape of the blood. It is also ab- 
sorbed by the bronchial mucous membrane, and is thus 
to be used in cases of anaemia, with an ulterior view as 
to its ordinary therapeutical effect. It is to be resorted 
to in threatening cases, but is contraindicated in the 
febrile states of phthisis, and in delicate individuals 
with great sensitiveness and irritability of the mucous 
membrane. Lewin mentions the case [op. cit., p. 348) 
of a lady in whom the inhalation of a solution of the 
sesquichloride of iron employed for a profuse bronchor- 
rhoea always induced a slight haemoptysis, even when in 
the proportion of but half a drop of liq. ferri sesqui- 
chlorid. to the ounce of water. 

In using these ferruginous inhalations, care must be 
taken to protect the teeth. 

Lewin suggests the possibility of the iron exciting a 
plastic exudation in a pulmonary cavity, the same as 
when injected into the sac of a hydrocele, &c. 

The strength of the solution used for the purpose of 
arresting haemoptysis varies considerably with various 
authorities. From two to five grains to the ounce is am- 
ple, for a small proportion of iron will coagulate a large 
quantity of blood. Prof. Zclekauer employed a drachm 
to six ounces of water, half of which quantity was in- 






INHALATIONS ARE APPLICABLE. 151 

haled at each sitting by means of Mathieu's instrument. 
And by the way, the instrument of Mathieu, if at hand, 
or the insufflator of Bergson with the double bulb, on 
account of the low temperature of the spray they pro- 
duce, is preferable in these cases to the steam apparatus. 
In cases of great danger, where the patient's strength 
must be economized to the utmost, the proportion of 
iron in the solution can be increased, in order to diminish 
the time of inhalation. 

Tannic acid also, coagulates the blood, is an astrin- 
gent, and diminishes secretion. It is said to be less apt 
to excite inflammation than iron, and its influence is 
probably more continuous. It is indicated in the milder 
cases of haemoptysis, the so-called passive hemorrhages, 
and when inflammation is present ; also in cases where 
it may not be desirable to introduce iron into the blood ; 
in the bloody sputa of bronchorrhoea, where it comes in 
play as an antiseptic. It can be administered in larger 
doses than the iron, — say from ten to twenty grains to 
the ounce. 

Alum coagulates the blood, and is like tannin, — as- 
tringent and antiseptic. It is more suitable than tan- 
nin in acute inflammatory conditions ; and not being 
absorbed by the mucous membrane, is indicated in cases 
where it is not desirable to impress the organism. 

Other astringents, metallic and vegetable, have been 
employed in haemoptysis, and serve a useful purpose, 
though they can hardly replace iron, tannin, and alum. 

It must not be forgotten that many pulmonary hem- 
orrhages cease promptly without the introduction of a 
haemostatic ; which fact renders it difficult, in ordinary 
cases, to judge of the exact value of the inhalations. 

That ferruginous inhalations have often saved life by 



152 DISEASES TO WHICH NEBULIZED 

promptly arresting haemoptysis and keeping up contrac- 
tion of the bloodvessels, is abundantly attested by the 
records of many hundred cases from the pens of the 
various observers. 

One or two striking examples are introduced in illus- 
tration : 

Fieber (op. cit. p. 141) relates a remarkable case in a 
man whose whole family were predisposed to affections of 
the respiratory organs, and several of whom were suffer- 
ing from pulmonary and tracheal troubles. About fifteen 
years previous, the patient, at that time twenty years old, 
while journeying in winter, was attacked with haemoptysis 
and pneumonia. Various treatment had been employed 
for the cough, &c, without success. Dr. Wagner be- 
came acquainted with the patient in 1860. At that 
time he had an exceedingly severe cough, with profuse, 
bloody expectoration. The apices of both lungs were 
infiltrated with tubercles, the right one to a very great 
degree. The sound on percussion was dull, and the res- 
piratory murmur almost entirely bronchial. The region 
under the right clavicle became more and more sunken 
in, slight pains in the right thorax and under the right 
shoulder-blade were complained of, and the patient 
emaciated greatly. Whey, cod-liver oil, and mild 
narcotics with quinine, were of benefit, so that after a 
while the patient felt like travelling and resuming his 
employments, but desisted from so doing on account of 
his catarrh and slight attacks of haemoptysis. In the 
year 1861, the patient complained of a sense of weight 
in the right loin and the right testicle, which latter organ 
was enlarged, hard, uneven, and painful on pressure. 
This was attributed to strain at stool. All the emol- 
lient, soothing remedies, in connection with rest, &c, 






INHALATIONS ARE APPLICABLE. 153 

produced no effect. The diagnosis pointed to tubercu- 
lous infiltration. A suspensory had to be worn. The 
patient's appetite was always moderate ; bowels consti- 
pated, requiring laxatives. He would lose flesh and 
regain it and lose it again. Continued speaking and 
physical fatigue were very well borne. Early in De- 
cember the bronchial catarrh exacerbated and increased 
to a very great degree. At the same time he became 
subject to attacks of haemoptysis of such vehemence that 
his life was in constant danger. This condition had re- 
mained, in spite of all remedies, for more than five 
weeks, when, on the 9th of January, inquiry was made 
of Dr. Fieber whether it would be possible by means of in- 
halations to keep the patient alive for three or four days 
to see his brother, whose arrival was expected at that 
time. Fieber found the patient in a state of great helpless- 
ness, hardly able to move himself, and barely able to con- 
verse. A thorough examination — which would have been 
superfluous — was impossible. All sorts of remedies had 
been so ineffectual that the patient had discarded medicine 
and contented himself by sucking enormous quantities 
of small pieces of ice. On the day, on the evening of 
which the inhalatory treatment began, four pints (seitel) 
of blood were expectorated. With little hope of good 
result, the inhalation was begun that 9th of January, the 
greatest care being necessary for fear of exciting even 
a moderate paroxysm of cough, which would have re- 
sulted in a hemorrhage which might have proved fatal. 
A solution of the sesquichloride of iron (which, by the 
way, had been given by the stomach with no better effect 
than anything else), two scruples to two pounds of spring- 
water, was placed in the second model of Charriere's ap- 
paratus, and only such pressure exercised as absolutely 



154 DISEASES TO WHICH NEBULIZED 

necessary to nebulize the fluid. The patient was per- 
mitted to inhale this so cautiously that a quarter of an 
hour's rest was allowed after every fifth inspiration. 
Three such sets of inspirations were given in the forenoon 
and the like number in the afternoon, so that he took, 
daily, thirty inspirations. The number was subsequently 
increased to forty-eight, and the proportion of the iron 
increased to a drachm. The result was a happy one. 
On the 10th of January the patient expectorated only 
one pint of blood. The sputa remained bloody until 
the 14th, and after that, they continued free from tinge. 
The patient was of a very irritable temperament, and 
every irritation induced congestion to the lungs. This 
was the reason that later, after any considerable emo- 
tion, the sputa became tinged with blood, though this 
would quickly disappear. On the first day of February, 
a narcotic solution was substituted for the ferruginous 
one, in order to diminish the catarrhal phenomena. At 
the end of April the inhalations were discontinued. 
The strength of the patient, meanwhile, had so increased 
that he was subsequently able in the beginning of June 
to travel to Roznan for the purpose of undergoing the 
whey-cure; and there Dr. Polansky resumed the inhala- 
tions, employing tannin. Dr. Fieber saw the patient 
again at Vienna, in August ; he had improved very 
much in appearance, and was about departing for Berlin 
to rejoin his relatives. 

Zdekauer reported (Wien. Med. Woch., 1861) a re- 
markable case of arrested hemorrhage, in which the 
presence of iron in the lung was demonstrated after 
death. This case is detailed byLewin (op. cit. p. 240), 
and is as follows : 

J. B , an invalid soldier, was sick with Bright's 



INHALATIONS ARE APPLICABLE. 155 

disease, with albuminuria and consecutive dropsy. Close 
examination revealed the existence, at the same time, of 
hypertrophy of the heart, and either insufficiency of the 
mitral valve, or atheromatous excrescences in the aorta. 
The diagnosis was difficult on account of the pressing 
upwards of the diaphragm by ascites; and the short, but 
rough respiratory murmur was so loud and difficult to 
restrain, that only an occasional systolic murmur could 
be heard ; while percussion elicited the existence of an 
enlargement of the heart. 

Milk, diuretics, nitrate of potassa, and other remedies, 
were all ineffectual. The dropsical exudation and effu- 
sion increased rapidly ; the patient could only breathe 
when sitting in an arm-chair. One day he was attacked 
with suffocation, followed by a terrific hemorrhage, 
which seemed to have no disposition to cease. 

The apparatus of Mathieu happened to be at hand, 
as well as a solution of the chloride of iron, so that 
the resort to inhalation was made immediately. The 
poor patient just about breathed, or rather gasped for 
breath, and in two minutes he had fainted. He was 
soon restored to consciousness by sprinkling cold water 
upon his face, and he was made to inhale the solution 
for two minutes, when the hemorrhage ceased as if cut 
off short ; but it had exhausted the remaining strength 
of the patient, who died two days after with suffocative 
phenomena. 

Autopsy. Bloody serous exudation in the right pleu- 
ral cavity floating the lung. In the right lung several 
insulated blood clots, of very dense consistence, and not 
bloody when cut into. In the left lung, similar blood- 
clots, but much smaller. The heart hypertrophied and 
covered with fat. Atheromatous deposit in the ascend- 



156 DISEASES TO WHICH NEBULIZED 

ing aorta ; insufficiency of the mitral valve. The left 
kidney much degenerated, the right one less so. Serous 
infiltration and effusion everywhere. 

Dr. Holm examined the blood clots, and found in all 
parts of the lung-structure iron in much larger quanti- 
ties than could be attributed to the iron of the blood. 

It is an important fact, that this very hemorrhage, 
which arose from great stagnation of the blood and 
regurgitation into the vessels of the lungs, was arrested 
by the inhalation of a watery spray containing chloride 
of iron, and that on the corpse could be demonstrated 
the deep penetration of the solution into the very bleed- 
ing tissue of the lung. 

Phthisis JPulmonalis. 

Fieber reports (Lewin, op. cit. p. 244) in detail a 
remarkable case of inferred phthisis in a married 
woman set. 38, with exacerbating paroxysm of cough 
and vomiting every night about three o'clock A. M. 
Her general condition was improved by tonics — bark 
and quinine — but without any impression upon the se- 
verity of the cough, or the amount of the sputa. Nar- 
cotics and demulcents were of no avail. Then, aban- 
doning all remedies except tr. cinchonge, he instituted 
inhalations with the pulverisateur. Within twenty days 
the patient took, in all, 3635 inhalations {inspirations) ; 
the smallest number in any one day being 40, the largest, 
300, the average, 240. This treatment began Septem- 
ber 12, 1861, with 40 inhalations of the spray of pure 
water. September 14th, 80 inhalations, consuming five 
minutes, of a solution of tr. opii simplex gtt. iij ad aq. 
dest. fgj. The soothing effect being trifling, he increased 
the proportion to five drops, and on the 16th she took 80 



INHALATIONS ARE APPLICABLE. 157 

inhalations, and the soothing effect was greater; 17th, 
100 inhalations in five minutes ; 18th, 5 grains of alum 
was added to prevent too great a degree of somnolence, 
which showed itself particularly towards evening; and 
of this, 75 inhalations in four and one-half minutes ; 19th, 
160 inhalations in ten minutes ; 20th, 21st, 22d, each 
day 240 inhalations in fifteen minutes. Now she coughed 
verp little during the day, and the expectoration had 
decreased. The nightly paroxysms of cough had lost 
nothing of their intensity. He then determined to make 
an experiment with an antiperiodic mixture, and on 
the 23d, the patient took 200 inspirations of a fluid con- 
taining to the ounce of water, 2 grs. quin. sulph. (of 
which 0.64 grs. dissolved, the rest remaining suspended) 
tr. opii gtt. vij, alumen gr. v. Nothing peculiar was 
noticed during the inhalation, but haemoptysis occurred 
on that day, and also on the succeeding day, in all 
together to the amount of about four teaspoonfuls of 
blood, alkaline in reaction ; and there was increase of 
the catarrhal symptoms. The patient complained of 
the benumbing sensation produced by the alum, and of 
its taste ; and on the following day, September 25th, she 
took 120 inhalations, in seven and one-half minutes, of 
a mixture of 5 drops of tr. opii, 7J grs. tannin, and one 
ounce of water. This solution was retained to the end 
of the treatment. The catarrh decreased ; the sputa 
showed less blood. September 26th, no blood in sputa ; 
catarrh trifling. The nightly paroxysm suspended for 
an hour, appeared at four A. M., and was less intense 
than heretofore. Patient complaining of weariness ; no 
inhalation ; 27th, 240 inhalations in fifteen minutes, 
paroxysm again at four A. M.; 28th and 29th, same 
treatment, paroxysm came on at five A. M., and for the 

14 



158 DISEASES TO WHICH NEBULIZED 

first time so modified that the patient did not vomit 
towards the last of it, as had been the case since June ; 
on the 29th, the patient thought that she had overslept 
her paroxysm, but it came on, however, at six A. M.; 
30th, no inhalation ; paroxysm came on at seven A. M., 
and still weaker. October 1st, no paroxysm, 240 inha- 
lations. Patient can now inhale without producing the 
least disposition to cough, which had always been*the 
case, more or less, until this day. She has been sleepier 
than usual for several days, owing to the effect of the 
opium inhaled. October 2d, 250 inhalations ; 3d, no 
inhalations ; 4th, 5th, and 6th, each day 240 inhala- 
tions. At this point the treatment was discontinued, 
as there had been no paroxysm for several days, but 
little cough, and very trifling secretion. The percus- 
sion was the same as at the beginning of the treatment, 
but of the catarrhal r&les, there remained only some 
rude respiration on the left side. 

Another case from the same source. Tuberculosis 
of left lung, haemoptysis, intense cough, marked improve- 
ment under inhalations of opium and alum. Patient, 
a man set. 28, feeble, emaciated, tuberculous infiltration 
of left upper lobe, cough intense and painful, expec- 
toration easy but very profuse, pulse 120. Treatment 
began May 10th, with inhalations of tr. opii f5ij, aq. 
dest. lbij, 20 inhalations in the morning and 10 in the 
evening, increased by the third day to 30 in the morn- 
ing and 20 in the evening, with decrease in the fre- 
quency of the cough and in its intensity, decrease of 
moist rales, and reduction of pulse to 108. Now, alum 
5ij was added to the opiate solution; expectoration de- 
creased, strength increased. June 17th, 40 inhalations 
in the morning, 30 in the evening. July 1st, 50 in- 



INHALATIONS ARE APPLICABLE. 159 

halations morning, 40 evening. July 2d, 50 inhala- 
tions morning and evening. Three grains of quinine 
were now added daily. Then the strength of the patient 
increased in a marked degree. After several nightly 
excesses, on July 9th a slight haemoptysis, not followed 
by any injurious results. Early in August the catarrh 
was reduced to a minimum, and the patient returned to 
his own residence. 

Lewin (op. cit. p. 45) closes his own record of cases 
of phthisis treated by the new method of inhalation, 
with the following, in which the result promised a per- 
manent cure. 

Tuberculosis Laryngis et Pulmonum. — Judge K., of 
Bromberg, get. 39, of slender build, feeble constitution, 
and phthisical diathesis, is the offspring of healthy, 
sturdy parents, still living. His mother, however, suf- 
fers from cough. He has three sisters, and they are 
healthy. Of the exanthemata, he has had only scarlet 
fever in his seventh year. 

In 1841, after great exertion and exposure to cold, 
he contracted a " gastric nervous fever," from which he 
recovered after a period of six weeks, but of which he 
soon had a relapse which lasted another six weeks. 
Since this time he has remained weak and feeble. 

His present illness is attributed to an overheating 
followed by a cold, during an exhausting official sitting 
in 1855. The disease set in with chill, heat, fever, 
considerable cough, and subsequent emaciation. He 
then sought recuperation at Reinerz, where by the use 
of its tepid springs, with the use of whey, he became 
tolerably well again. While travelling, in the following 
year, 1856, the cough returned, and has since remained 
permanent without alteration. 



160 DISEASES TO WHICH NEBULIZED 

. In the summer of 1862 the patient sought the min- 
eral springs at Ems, and not without some. benefit; but 
fourteen days after the treatment at that place had 
been discontinued, there set in a hoarseness with occa- 
sional small, lumpy, bloody expectorations. 

Soon after this he began to experience great difficulty 
in swallowing his food, so as to render the process very 
uncomfortable, and " he sate himself to his meals very 
reluctantly." The pain was felt principally during the 
first and third portions of the process of deglutition, 
and also by the passage of the bolus over the ulcerated 
epiglottis on one side, and the inflamed arytenoid car- 
tilages on the other. 

Present condition, June 2d, 1863 : The pitch of the 
voice is high, attenuated, and weak. The soft palate 
is redder in color than is normal. On the right side 
are many relaxed veins extending as far as the uvula. 

The circumvallate papillae are much enlarged, and 
project in a button-like manner. On the right side of 
the root of the tongue is a thread-like vein with lateral 
varicosed branches, extending almost to the anterior 
attachment of the epiglottis. 

The follicular glands are more swollen on the right 
side, less prominent on the left. Two very full glands, 
superficially ulcerated, are seen upon the glotto-epi- 
glottic ligament. 

On the anterior border of the epiglottis, particularly 
the left side extending beyond the middle line, is a loss 
of substance with tuberculous characteristics. The bor- 
der of this defect of the epiglottis shows a small swelling 
on its free extremity where it approaches the sound por- 
tion of the left side, and, rather more upon the inferior 
surface, a button-like excrescence. The inferior sur- 



INHALATIONS ARE APPLICABLE. 161 

face of the epiglottis in the neighborhood of this defect 
is yellowish and cicatrized, and the protuberance of the 
epiglottis can scarcely be seen. 

The ary-epiglottic folds are more swollen on the 
right side, and there is a small cicatrix upon the left. 
The mucous membrane of the arytenoid cartilages is so 
cedematous from infiltration that it cuts off almost com- 
pletely the view of the vocal cords, permitting only 
their anterior attachments to be seen, at which point 
their color is reddishly livid. 

The false vocal cords are dark red in color and very 
much swollen, and on the right one there is a superficial 
erosion. 

The anterior wall of the trachea, as far as can be 
seen, is colored as from a recently contracted catarrh. 

The larynx is painful to pressure. The neck is 
small, thin, and long. The contour of the thorax is 
flat, depressed, and paralytic. On the right side, be- 
neath the attachment of the clavicle to the sternum, is 
a longish depression, and the whole region beneath the 
right clavicle is sunken in. Inspiratory elevation but 
slight. The panniculus adiposus gone. 

Percussion in the right supra-clavicular region elicits 
a dull, empty sound ; on the left side, normal. In the 
internal supra-clavicular region of both sides, the sound 
on percussion is alike and normal ; externally, on the 
contrary, it is clearer upon the right side than on the 
left. 

In the intrascapular region the sound on percussion 
is dull on the right side ; otherwise everything is normal. 

Cardiac dulness rather increased. 

Auscultation reveals anteriorly in the left supra- 
clavicular region, undoubted sonorous rales in the apex 

14* 



162 DISEASES TO WHICH NEBULIZED 

of the lung. On the right side, undetermined respira- 
tion. Vocal vibration and fremitus stronger over the 
right thorax than over the left. 

Puerile respiratory murmur posteriorly, but much 
weaker on the right side than on the left. 

The patient inhaled, during six weeks, at first com- 
mon salt alone ; later with the addition of the bicarbon- 
ate of soda, both in the same proportion, gradually in- 
creased to §ss. to 24 oz. of water, to which at times a 
little tincture of opium was added. The beneficial 
effect was not temporary only, it was continuous ; and 
to-day (reported in 1865) the patient still remains com- 
paratively well, and pursues his laborious avocation in 
K . 

In this case the positively beneficial result was re- 
markable, for the tuberculous process in the lungs took 
on a retrograde movement. 

I have had the opportunity of watching the effects of 
inhalations of nebulized solutions in a number of cases 
of phthisis, seven of which continued under my observa- 
tion until their fatal termination. One of these was the 
most intimate friend I ever had. The inhalation of tar- 
water, of an infusion of wild cherry bark, of slightly 
narcotic solutions, afforded a great deal of relief to his 
cough and his dyspnoea ; and when he left the city, 
about a year before his death, to try again the effects 
of a warmer climate, during a residence in which, from 
some ten years previous until shortly anterior to the 
commencement of the late war, he had been compara- 
tively well, — that is, well enough to attend to business 
at all seasons, — he took his Siegle's apparatus with him, 
and from time to time employed it as he found it neces- 
sary to resort to its palliative influence. 



INHALATIONS ARE APPLICABLE. 163 

In another case, that of a medical friend and former 
schoolmate, the relief to the dyspnoea from these inha- 
lations was far greater than had been procured by any 
other method. This gentleman preferred the tincture 
of hyoscyamus, ten drops to the ouncO of water, or of 
infusion of wild cherry bark, and often told me that 
the inhalation of half this quantity was sufficient to 
place him perceptibly under the narcotic influence of 
the hyoscyamus. 

I have chiefly employed hyoscyamus and infusion of 
wild cherry, with an occasional astringent when the 
expe'ctoration was profuse and exhausting ; and tar- 
water as an antiseptic. The inhalation of warm water 
alone will facilitate expectoration'. All of these cases 
experienced great relief from the topical effect of the 
inhalations. I have not had an opportunity of observ- 
ing the constitutional effect of inhalations in the early 
stage of the tuberculous deposit, but since the report of 
Mr. Broadbent's success with the injection of acetic 
acid in cancerous and other tumors, I have been anxious 
to try its effect by inhalation upon tubercle. 

Dr. J. R. Wolfe, of Aberdeen (Med. Times and 
Gazette, Nov. 25, 1865 ; Brit, and For. Med. Chir. 
Rev., Oct. 1866, p. 538), writes : Prof. Longet lately 
made some experiments on himself with phenic (car- 
bolic) acid for an attack of haemoptysis and tuberculo- 
sis, and was so much relieved that the substance is now 
largely employed by several French physicians. Dr. 
Labort, of Yincennes, informed Dr. Wolfe that he had 
administered it to between two hundred and three 
hundred patients in different stages of phthisis with 
marked benefit. The mode of administration was the 
following : Fifteen drops of the pure acid were dissolved 



164 DISEASES TO WHICH NEBULIZED 

in two ounces of spirit, and the solution mixed with 
thirty-two ounces of water, and this quantity was ad- 
ministered daily, partly by the stomach, and partly by 
the inhalation of the fluid in a pulverized state, by some 
of the instruments now in use for reducing fluids to fine 
molecules- It is remarked by Dr. Wolfe that as an 
adjunct to cod-liver oil, the phenic acid is beneficial in 
all stages of phthisis, but he considers it eminently useful 
in suppressing hemorrhage from the lungs, in allaying 
irritation, and arresting profuse secretion. 

The inhalation of carbolic acid has been tried in 
the Pennsylvania Hospital, and in private practice by 
Dr. J. Forsyth Meigs, of this city, who finds it of 
value as a palliative in phthisis. 

Pulmonary G-angrene. 

In relation to this affection Dr. Beigel states (op. 
cit. p. 190) that when he was physician to the Spa of 
Reinerz, he remembers some cases who had visited that 
resort in the hope of procuring relief from the fetid 
odor of their breath ; and he relates the case of a 
young Russian, set. 21, who had been subject to phthisis 
for years, and in both of whose lungs there were signs 
of large cavities. The breath of this patient was so 
fetid that he found great difficulty in securing apart- 
ments. He was made to inhale a solution of chloride 
of lime (one drachm to the ounce), which did not cause 
any cough ; and though its effect was unmistakable, 
liquor chlori. (one part to six parts of water) was sub- 
stituted, which made the patient's condition much more 
tolerable. He inhaled nearly every hour, and almost 
from the first inhalation, the improvement was so 



INHALATIONS ARE APPLICABLE. 165 

marked that one could remain with him a quarter of an 
hour or more, which before had been impossible. 

Trousseau speaks of the value of tannin, extract of 
rhatany, sulphate of copper, corrosive sublimate, and 
arsenate of potassa in this affection when administered 
by inhalation, the doses at first to be very small, and 
increased gradually as the organism becomes accustomed 
^to their influence (Clinique Medicate de V Hotel Dieu, 
Paris, 1861, p. 583). 

Pulmonary Emphysema. Asthma. 

Wistinghausen (Peter sburger Med. Zeitschrift, 
1862, xvii, p. 137, quoted by Lewin, op. cit. p. 242) 
reports the following case cured by inhalations of Fow- 
ler's solution of arsenic. A young girl, set. 15, whose 
mother had died of tuberculosis, had suffered from child- 
hood with laryngeal and bronchial catarrh, eventuating 
in emphysema of both lungs with asthmatic paroxysms. 
After the employment of a great variety of remedies, 
external and internal ; after a residence during three 
summers at Wielbach and Ems, at Salzbrunn ; and the 
resort to local gymnastics during two winters — all 
without beneficial result — she was, at the suggestion of 
Prof. Eck, placed under the treatment by inhalation 
of solut. arsen. Fowleri gtt. x-xv-xx, pro aq. destil. 
f§j, once or twice a day. The same remedy had been 
administered inwardly without advantage, as had also 
ss t0 i g r - °f nitrate of silver, four times a day. After 
ten days of inhalation (ten minutes each day) the asthma 
ceased entirely, and, the inhalations being continued, 
did not return during the severe and cold w T inter and 
the variable spring of 1861. The patient could expose 
herself in all weathers without using the respirator, 



166 DISEASES TO WHICH NEBULIZED 

with which until then she had been unable to dispense, 
even during a short promenade. She could also join 
in the dance until late at night without any trace of 
shortness of breath, though before this treatment, the 
very excitement of receiving an invitation to a company 
would bring on a severe attack of asthma. The aus- 
cultatory phenomena had not altered much, the mucous 
sibilant rales having subsided only in the right scapu- 
lary region. 

The patient had inhaled in all four ounces of the 
Fowler's solution, without any symptoms of arsenical 
poisoning. After this, she inhaled tannin, gr. x ad 
f§j, and after a time, ext. Turion. pini in the same 
strength, thirty drops at each time. Sales-Girons' ap- 
paratus was employed. Mathieu's instrument was em- 
ployed once, but was uncomfortably cold. 

Lewin also recommends the use of Fowler's solution 
of arsenic, from half a scruple to half a drachm, to 
twelve ounces of water. He relates (op. cit., 442-446) 
several cases in detail which he subjected to this treat- 
ment with benefit. Sometimes he added to the solution 
some common salt. He also, and occasionally with 
benefit, used the oleo-balsamic mixture, 5j to half the 
ounce of aqua castoreii. 

Waldenburg (op. cit., 277-294) reports good results 
from solutions of common salt, tincture of opium, and 
oleum pini. 

Siegle (op. cit., p. 82) reports favorably on the effect 
of common salt. 

Leibllnger recommends, in emphysema, the inhala- 
tion of the ol. terebinth, gtt. j to the fluid ounce of warm 
water, and also the ol. cadini, gtt. ij to the ounce. 

I have seen a good deal of benefit from inhalations of 



INHALATIONS ARE APPLICABLE. 167 

a weak solution of iodine, with and without combination 
of iodide of potassium, in a single instance of emphy- 
sema from chronic bronchitis, which has come under my 
own observation. 

Syphilitic Ulcerations. 

Dr. Johann Schnitzler (op. cit.) reports two cases 
of syphilitic ulcerations of the naso-pharyngeal space, 
and of the larynx, very quickly cured by inhalations of 
a solution of corrosive sublimate, a grain to the ounce. 
The cleansing of the ulcerated surfaces could be demon- 
strated with the laryngoscope after each inhalation. 

Demarquay (op. cit. Lewin, p. 223) found rapid im- 
provement in syphilitic affections of the soft palate, the 
pharynx, and the larynx, under the influence of nebu- 
lized solutions of corrosive sublimate, 25 centigrammes 
to 500 grammes of water, which he found the best of 
all topical remedies in connection with internal treat- 
ment. The inhalations were taken three to four times, 
and each time from five to six minutes in duration. 

In several cases he saw very circumscribed mucous 
patches of these parts disappear rapidly. He remarked 
this particularly in an old man who suffered with great 
hoarseness, and on whose palatum molle there were such 
mucous patches. A general treatment previously in- 
stituted had afforded no relief, but he improved promptly 
under the new method. 

The Sore Throats accompanying the Exanthemata. 

The management of the sore throat in cases of scar- 
latina and other exanthems, is often a matter of great 
difficulty, especially in young children, w T ho cannot be 
coaxed into co-operation for the relief of the local symp- 



168 DISEASES TO WHICH NEBULIZED 

toms. Where the patient is too young to gargle, or 
too feeble to do so, there is often great trouble experi- 
enced in making local applications by the mop or the 
syringe, to say nothing of the inefficiency of the method, 
and the eifect of struggling on the constitution of the 
patient. With the nebulizer, especially if the duck-bill 
tubes are used, we have a means of making local appli- 
cations at once agreeable and efficient, and can, there- 
fore, to a certain extent, control the local inflammation. 
In one very bad case of anginose scarlatina in my own 
family, in which my friend Dr. Alfred Slocum of this 
city was called to my assistance, we had ample proof 
of the value of this treatment. The case was a very 
severe one in every particular, and considered danger- 
ous from the very onset, and both physicians predicted 
an unfavorable termination. When the little fellow, 
a boy of seven years of age, could not by any means be 
induced to take a drop of medicine or nourishment, he 
never, after the first application of the nebulized spray, 
refused its repetition, but opened his little mouth, as 
far as the swelling would permit, to receive the grateful 
shower, and he often made motions asking for its use. 
It would have been impossible for this child to have 
gargled ; he resisted with all his force, the application 
of a mop for the extraction of the profuse secretion from 
his swollen tonsils, and I firmly believe that but for the 
relief to the anginose symptoms, the patient would have 
died. We used the apparatus of Dr. Andrew Clarke. 
The case was the most threatening one I ever saw re- 
cover, and the patient was confined to his bed for six 
weeks, the disease being followed by nasal and aural 
catarrh, dropsy, intermittent action of the heart, long- 
continued swellings of the lymphatics of the neck, &c. 



INHALATIONS ARE APPLICABLE. 169 

The material used in this instance was chiefly a solu- 
tion of the permanganate of potassa, just strong enough 
to give the water a decidedly pink tinge ; and occasion- 
ally, as the symptoms were more acute, a weak solution 
of alum water. These inhalations were administered 
hot, by placing the apparatus, for a few moments before 
using it, in a vessel containing hot water. When the 
patient called for the application at other times than 
when regularly ordered, the instructions were to employ 
hot water simply. 

My friend, Dr. James Collins, of this city, commu- 
nicates the following case : Scarlatina anginosa. B , 

set. 6 years. Called January 25, 1867. After an infu- 
sion of capsicum and a saturated solution of chlorate 
of potassa had been used topically without apparent 
benefit, inhalations of creasote water gtt. vj to f§j, were 
begun on the third day of the disease, and administered 
at first every hour, and subsequently every second hour. 
The anginose symptoms were at once greatly relieved, 
and the child fell asleep breathing much better than 
she had done before. 

The symptoms in this case were threatening from the 
beginning, and it terminated fatally on the sixth day. 

There is no doubt as to the local benefit of the inha- 
lations ; they were evidently very soothing, and the pa- 
tient was more comfortable from the time they were 
employed. 

Supporting treatment was instituted, in conjunction 
wifh chlorate of potassa and tincture of belladonna. 

Some observations on the sore throat of small-pox, 
and its extension as far as the trachea, have been made 
by Naumann and Semeleder, the symptoms of the 
ulceration being much those of severe catarrh. Astrin- 

15 



170 DISEASES TO WHICH NEBULIZED 

gent and narcotic inhalations had considerable influence 

in lessening the laryngeal complications (Baumgartner 

op. cit., p. 90). 

In the catarrh accompanying typhus fever, Ruhle 

observed favorable results from the antiseptic influence 

of inhalations of tannin (Baumgartner, op. cit., p. 91). 

• 
Pneumonia. 

But few observations have been made in the treat- 
ment of pneumonia by inhalation" of nebulized fluids. 
Siegle remarks (op. cit. p. 85) that Auphan recom- 
mended the use of nebulized water at Euzet-les-Bains 
in hepatization of recent or of non-recent standing, 
though at the same time he considers inhalations con- 
traindicated in coexisting inflammatory fever. 

Diseases Other than those Affecting the Respiratory 
Organs. 

Sales-Girons has suggested (G-azette Medicate, Sep- 
tember 8, 1866) the employment of nebulized solutions 
by inhalation in certain stages of cholera, where absorp- 
tion having become impossible by the digestive tube, the 
lungs offer opportunity for the absorption of medicines 
into the system. 

The same idea occurred to Dr. Wittmeyer, of Nord- 
hausen (Deutsche Klinik, October 13, 1866), who pro- 
poses the inhalation of nebulized water to convey that 
fluid promptly to the thickened blood in the stage of 
asphyxia, and thus enable it to circulate more freely. 

Sales-Girons (G-azette Medicale, Sept. 8, 1866) and 
Ancelon (La Rev. Med., vol. 4, p. 598) have employed 
inhalations of the sulphate of quinine successfully in 
the treatment of intermittent fever. 



INHALATIONS ARE APPLICABLE. 171 

Anaemia, dyspepsia, and other affections, have been 
treated by the inhalation of nebulized fluids, with the 
view of affecting the system more promptly than by the 
usual method, especially in cases where the digestion 
has been impaired. The observations recorded are few 
and scattered, and, as yet, of too undecided value to 
justify a positive opinion as to their efficacy. 

Quite recently, Sales-Girons has presented a memoir 
on respiratory therapeutics, upon which M. Beclard has 
made a report to the Parisian Academy of Medicine 
(G-azette Hebdomadaire, No. 10, 1867). It is claimed 
that these inhalations may be safely resorted to in a 
great variety of diseases, for the purpose of producing 
constitutional effects, because the mucous membrane of 
the respiratory organs exceeds all other mucous mem- 
branes, including that of the small intestines as well as 
the stomach, in its powers of absorption, as a consequence 
of the rapid passage of the entire mass of the blood 
through the lungs, exposing, within the space of less 
than half a minute, almost every globule of that fluid to 
the action of any remedy, through the endosmotic action 
of an extremely attenuated membrane of great absorp- 
tive power. In proof of this capability of absorption, 
it is stated that twenty-five litres of water may be in- 
jected into the bronchi of a horse within six hours, and 
become at once absorbed without occasioning any sensi- 
ble injury to the animal. 

There may, therefore, be good grounds for Dr. Witt- 
meyer's idea of conveying water to the blood promptly 
in states of asphyxia, by means of its inhalation in the 
form of nebula. 

In cases of infectious and contagious diseases, and 
under other circumstances where it is desirable to pre- 



172 DISEASES TO WHICH NEBULIZED 

vent contamination of the atmosphere with the emana- 
tions from a patient or his discharges, or when it is de- 
sirable to disinfect an atmosphere already so tainted, 
we have a ready means of diffusing this purifying agent 
through the atmosphere of an apartment, by resorting 
to the process of nebulization, so as to divide it in the 
most minute manner possible. In this manner, one or 
more instruments can be placed in action in different 
portions of the room, and kept up sufficiently to main- 
tain a comparatively pure atmosphere. 

Upon this point, Dr. Da Costa writes me : " Having 
had a good deal of facial erysipelas brought into the 
wards at the Pennsylvania Hospital, and two cases sub- 
sequently developing themselves there, I used chlorin- 
ated soda. In a few minutes the whole ward was filled 
with the odor of chlorine, and during the whole day 
and evening the particles of soda burn flickeringly in 
the lighter gas with their characteristic yellow flame, 
a good proof of diffusion. Surely, to disinfect rooms, 
&c, there is nothing better." 

Then, also, in cases of disease where we wish to medi- 
cate the atmosphere with which the patient is sur- 
rounded, as with a terebinthinate or other impregnation, 
or simply to supply moisture, or to create an artificial 
sea-air, as was done in a more imperfect manner in 1845 
by Hirzel, of Zurich, who sprinkled an artificial sea- 
water from a small fountain, in the apartments of con- 
sumptive patients ; we can place one or more instru- 
ments in convenient localities and keep up such a medi- 
cation as is required, or renew it at proper intervals. 
So, too, in cases where patients are too feeble to make 
any effort at inhalation, and where it is impossible or 
imprudent to call their attention to the process, an in- 



INHALATIONS ARE APPLICABLE. 173 

strument may be set going in close proximity to them, 
in such a manner that a portion of the air they inspire 
shall contain more or less of the nebula. 

Summary. 

In reviewing the entire subject, as portrayed in the 
preceding pages, we may conclude that the employment 
of remedies in this form is by no means to be ignored or 
underestimated, as far, at least, as regards diseases of 
the respiratory passages ; that these inhalations are 
not to be used carelessly, for the reduction of tension 
in the air inhaled while loaded with nebula may induce 
congestion, which may prove detrimental, as in the case 
related by Fieber, in which haemoptysis was induced, 
and in the case related by Trousseau, in which fatal 
pneumonia was induced by the too-frequent inhalation 
of an astringent ; and as shown in the experiments of 
Demarquay upon rabbits, in whom the inhalations pro- 
duced pleuro-pneumonia ; that there is indubitable evi- 
dence of their great value in certain forms of sore throat, 
and particularly so in children ; that they can be resorted 
to with confidence to restrain hemorrhage, to subdue 
irritation and inflammations, to relieve dyspnoea, to re- 
press excessive secretion, to resolve exudation, — in fact, 
to do all for the respiratory mucous membrane that can 
be accomplished for other structures by the application 
of moisture, simple and medicated ; that under favorable 
conditions of system, apart from constitutional implica- 
tion, they are directly adequate to the cure of chronic 
affections of the respiratory organs that are at all cura- 
ble ; perhaps, in part, by inducing exercise of the parts 
as an essential element of the process, and thereby ex- 
citing restorative nutrition leading to resumption of 

15* 



174 NEBULIZED INHALATIONS IN DISEASE. 

normal function ; but that they are not, in themselves 
and by themselves, adequate to the cure of disease, in- 
dependent of general treatment ; that they are less ap- 
plicable to acute affections than to chronic, except in so 
far as they palliate special symptoms or relieve them ; 
that they are less efficient than local applications by the 
mop or sponge, in cases of thickening, or ulceration, or 
other evident change of structure in parts within reach 
of the probang ; and that, therefore, though not specific 
in the usual sense of the term, they are to be regarded 
as an invaluable addition to our approved methods of 
administering remedial agents, and as such entitled to 
our favorable consideration. 



ON INHALATION, 



PART II. 



THE INHALATION OF MEDICATED AIES, GASES, 
AND VAPOKS. 

Inhalations of oxygen, nitrous oxide, sulphuretted 
hydrogen, and other gases, can be administered at ordi- 
nary temperatures ; as also the vapors from chlorine, 
iodine, creasote, camphor, acetine, ether, chloroform, 
and, as highly recommended by Lewin, of muriate of 
ammonia in statu nascente. At an increase of temper- 
ature there can be employed in the same manner, the 
volatile ethereal oils, and the vapors from water and 
from decoctions of aromatic, resinous, and narcotic 
plants. 

Vapors may be inhaled, diffused through the atmos- 
phere of an apartment, or they may be conveyed directly 
to the respiratory organs by means of some of the appa- 
ratus to be employed. • 

The proper method of inhaling even gases and vapors 
from an inhaler must be acquired by the patient, other- 
wise the vapor will merely enter the mouth and reach 
the pharynx, or if it mixes with the air in the lungs, 
will do so by diffusion ; but with some effort the manner 
of effecting penetration into the lungs can be readily 



176 THE INHALATION OF MEDICATED 

acquired. That it is no easy matter to inhale a vapor, 
and that consequently, when vapors of stramonium, &c, 
are smoked, instead of being carried into the lungs by 
the inspiratory current, they impress the system sym- 
pathetically or otherwise by their effect upon the mucous 
membrane or nervous distribution of the pharynx, can 
be made evident by attempting to inhale the smoke from 
an ordinary cigar. As usually smoked, none of the 
smoke passes the glottis, and when the attempt to in- 
hale is made, it will be found to require considerable 
effort, and induce a paroxysm of cough with disagree- 
able sensations, even in the persons of inveterate smok- 
ers. A volume of smoke can be retained in the mouth 
without embarrassing respiration for a considerable 
time, which is proof positive that inhalation is being 
carried on behind the velum through the nares. Closing 
the nostrils the effect is different. 

The importance, then, of seeing that patients inhale 
properly is self-evident, for if they are merely directed 
to inhale, in many instances the attempt will be futile, 
and the method of course fall into disrepute. 

One great mistake often made is in having the water 
from which the vapor rises too hot. Usually a temper- 
ature of from 110° to 120° is all that will be requisite 
to disengage the vapor of vegetable substances, and the 
greater the volatility of the substance to be used the 
less th^ degree of heat that will be required. 

Dr. John Harwood, of London (On the Practical Use 
of Inhalations, $c, London, 1839), endeavored by ex- 
periment to determine the best temperature for inhala- 
tion, as also the temperature of the water necessary to 
produce the desired temperature of inhalation. This he 
did by retaining the bulb of a delicate thermometer in 



AIRS, GASES, AND VAPORS. 177 

the vapor within the inhaler, and successively passing a 
volume of twenty cubic inches of atmospheric air at a 
given temperature through the instrument, this volume 
of air being similar to that which is received by the 
lungs during diminished or impaired respiration ; and 
the passage of the current through the inhaler was con- 
ducted in the succession of the inspirations of breathing. 
It was thus ascertained that atmospheric air of 57°, 
when combined in its passage through the inhaler, with 
the vapor arising from 



Water at 100° 


afforded 


an 


inhalation of 79° 


" it no° 




It 


It 


" 84° 


u u 120° 




a 


" 


" 88° 


« (( 13QO 




it 


tt 


" 93° 


" 0< 140° 




tt 


it 


« 99° 


« <<150° 




(< 


tt 


« 104°. 



Dr. Harwood recommends water at from 110° to 135° 
as the best scale for ordinary purposes, 130° being the 
most suitable temperature. 

Inhalers for Vapors, Airs, $c. 

Mudge's inhaler is a vessel with a tight cover, through 
which pass two tubes, one extending externally from 
the upper surface of the cover to within half an inch of 
the bottom of the vessel, the other extending from the 
lower surface of the cover some six or more inches. 
The external tube is furnished with a mouthpiece, 
through which inspiration is to be made, expiration 
being performed through the nostrils. The desired 
fluid being placed in the inhaler, inhalation is effected 
by drawing into the lungs through the external tube, 
the air contained in the inhaler over the surface of the 
fluid ; the air is then resupplied from the atmosphere 



178 THE INHALATION OF MEDICATED 

by the inner tube, and passing through the medicinal 
fluid becomes impregnated with its active principle. 

Sm Charles Scudamore's apparatus is substan- 
tially the same. He employed a glass vessel with a 
double neck ; though a wide-mouthed bottle with two 
perforations through the closely-fitting cork will answer 
the same purpose. He directs that the water in the 
inhaler should be about an inch in depth, and to this 
the mixture to be inhaled must be added. He deems it 
important that the bottle should be large and the tubes 
capacious. The tube issuing from the bottle should be 
upright, passing gradually into a slight curve, so that 
the vapor should not be much cooled during its egress. 
The ingress tube should dip very near ^o the bottom of 
the vessel, that all the air introduced may become im- 
pregnated. The patient should be desired to inhale by 
a combination of a suction effort and a pretty deep in- 
spiration ; then to drop the under lip from the mouth- 
piece and make a free expiration, and thus continue 
the process, pausing occasionally to avoid fatigue, which 
would more certainly ensue by breathing quickly, or 
using an inhaler with small tubes, or containing too 
large a quantity of water. 

Most of the inhalers in use are modifications of 
Mudge's. In using these, the tongue can be placed 
against the end of the tube in the mouth during expira- 
tion, so that the expired air passes out through the 
nostrils, or otherwise the mouth must be removed from 
the instrument at each expiration, in order that the 
expired air shall not pass into the inhaler. By using 
a mouthpiece provided with a valve, as in the admirable 
apparatus of Beigel, described and depicted further on, 



AIRS, GASES, AND VAPORS. 179 

in the section on the inhalation of oxygen, this incon- 
venience is avoided. 

A different sort of inhaler was introduced by Prof. 
Max Langenbeck {Deutsche Klinik, 1861, p. 129), 
consisting of a flattened globe varying in diameter from 
three-quarters of an inch to an inch and a half, formed 
of two halves which screw together, after the medicated 
cotton, wool, or sponge has been placed in the interior ; 
a number of holes pn each side permitting the passage 
of the air. The instrument is placed partially within 
the mouth, the lips of which compress the projecting 
portion. 

An instrument virtually the same has been contrived 
by Dr. M. S. Buttles of New York {Med. Record, 
1866, p. 44), to which a rubber tube may be attached, 
so that the instrument may be entirely concealed within 
the mouth, the tube remaining outside to permit access 
of atmospheric air. These instruments can be modified 
for insertion into the nasal passages in treating nasal, 
or naso-pharyngeal affections. 

Dr. Pomeroy of New York {Med. Record, 1866, p. 
44), has modified this instrument, and Dr. A. P. Mer- 
ril, of the same city, has recently devised a very elegant 
affair on the same principle, much of the shape of a 
lead pencil, designed especially for inhalations through 
the nostrils. An ordinary % tobacco pipe answers the 
purpose fully. This method is adapted only for sub- 
stances volatile at ordinary temperatures. 

Dr. John Snow, of London, contrived an inhaler 
chiefly adapted for the inhalation of opium, but also ap- 
plicable to many other medicines. It is made chiefly of 
tin, and consists of a cylindrical chamber, between four 
and five inches in diameter, and three or four inches deep, 



180 THE INHALATION OF MEDICATED 

under the centre of which a spirit-lamp is placed. The 
bottom of the inhaler consists of a thin piece of talc, on 
which is placed a small capsule of Berlin ware, for the 
purpose of holding the extract of opium. A porcelain 
funnel-holder, which is placed on the talc, keeps the cap- 
sule exactly over the flame of the lamp. The talc 
allows sufficient heat to be transmitted to the opium, 
without conducting it to the sides of the inhaler, and, 
consequently, the air which is inhajed is not unduly 
heated. The lid of the inhaler is movable, and it is 
provided with a delicately balanced valve for the ad- 
mission of air, and is connected to a face-piece by means 
of an elastic tube of wide calibre. This face-piece 
covers the mouth and nostrils, and is a modification of 
that of Hawksley. It is flexible, the sides and margin 
consisting of thin sheet lead, lined with oiled silk and 
covered with leather, with an expiratory valve which 
can be moved more or less to one side from the opening 
it covers, so as to admit unmedicated air whenever the 
vapor feels too pungent. 

Forced Inhalation of Atmospheric Air. 

We know of the benefits derived by residents in 
mountainous regions, and by the pedestrian tours and 
other gymnastic exercises to which pugilists are sub- 
jected during training, which, developing their respira- 
tory capacity, increases their strength and powers of 
endurance. 

In individuals with weak lungs, in those of sedentary 
habits, whose pulmonary organs are rarely properly 
aerated, the habitual employment of a number of forced 
inspirations of fresh air at stated hours, will soon exert 
a beneficial influence. The result will be facilitated by 



AIRS, GASES, AND VAPORS. 181 

forcibly straightening out the shoulders, either volun- 
tarily or with the aid of an assistant, during the inspi- 
ration, which should be slow and through a small oval 
aperture, or through a quill, round which the lips are 
closed ; and the position of the arms being maintained 
during the expiration. 

r 

Forced Expiration and Inspiration for the Relief of 
Spasmodic Asthma. 

Dr. J. S. Monell, of New York, writes to the editor 
of The Medical Record of that city (see No. for Aug. 
15, 1866), that in December, 1865, about nine o'clock 
one evening, he was having a severe attack of asthma, 
to which he has been subject for fifteen years. He 
placed himself standing at the foot of his bed, with his 
arms folded upon the foot-board for a pillow, the fore- 
head resting upon the folded arms, and the feet placed 
at a sufficient distance to make a partial semicircle of 
the body. While laboring severely for air, the thought 
occurred to him to cease breathing for a few seconds. 
He did so, and after several trials experienced some 
relief. He then expired all the air that it was possible 
for him to do, after which he determined not to inspire 
again until he found it absolutely necessary. He suc- 
ceeded in waiting several seconds, then inspiration was 
carried to its fullest capacity, and retained with great 
effort for many seconds. This act of forced expiration, 
waiting, thorough inspiration, and again waiting, was 
continued for some fifteen minutes, and to his delight, 
the spasm was perfectly relieved. He has since relieved 
several similar attacks by the same method, in less than 
two minutes. He has advised this course for many 
others, and their testimony has been uniformly satis- 

16 



182 THE INHALATION OF MEDICATED 

factory, except in one instance, that of an aged lady 
with heart disease. It requires a great effort on the 
part of the patient to perform this act. The first at- 
tempt at retaining the inspired air during the asthmatic 
attack, will cause the patient to think he cannot con- 
tinue it, but perseverance will soon delight him with 
relief from the spasm. 

The Inhalation of Compressed Air, 

In the latter part of the last century, the attention 
of scientific men was directed to the influence of con- 
densed air upon animal and vegetable life ; and the re- 
sult of certain experiments upon animals led to the 
suggestion that the respiration of compressed air might 
be beneficial in certain cases of disease. 

E. Tabakie, Dec. 7th, 1832, made a communication 
upon the subject to the Acade*mie des Sciences, and in 
August, 1835, M. Junod reported to the same body the 
result of his own experiments upon the human subject. 
Later, under the directions of M. Tabarie, the method 
was employed in the treatment of disease by Bertin of 
Montpellier, Pravaz, Milliet, of Lyons, — who reported 
some cases of phthisis apparently benefited in the first 
and second stages, — and others. Milliet's work, Be 
V Air Comprime comme agent Therapeutique, Lyons, 
1854, contains (Lewin, op. cit., p. 5, note) the record of 
twenty-two cases, including asthma, pulmonary conges- 
tion, emphysema, hepatization, phthisis, bronchial ca- 
tarrh, chlorosis, whooping-cough, laryngo-tracheitis, 
broncho-tracheitis, bronchitis, and chronic pneumonia. 
Bertin' s work, Etude Clinique de Vemploi et des Effets 
du bain d' 'Air Comprime dans le Traitement de Diver ses 
Maladies, Paris, 1855, contains (Lewin, op. cit., p. 5, 



AIRS, GASES, AND VAPORS. 183 

note) thirty-five observations in bronchitis, acute and 
chronic, chronic angina with aphonia, chronic pharyn- 
gitis, aphonia, bronchial catarrh, pulmonary oedema, 
emphysema, asthma, haemoptysis, chronic pneumonia, 
and phthisis. 

Sandahl (Om Verhningarne of ' for tat ad Luft, Stock- 
holm, 1862 ; see Lewin, op. cit., p. 6, note) reports the 
statistical observations of three hundred and fifty-three 
cases, of which there were one hundred and forty of dis- 
eases of the larynx and trachea, seven of pneumonia, 
twenty-two of asthma with emphysema, thirty-one of 
tuberculosis, five of organic valvular insufficiency of the 
heart, ten of anaemia, and thirty-five of aural catarrh. 

Tabarie's apparatus consisted of a wrought iron 
spherical chamber, capable of accommodating from one 
to a dozen patients ; air under a pressure of from J to 
| atmosphere, was forced into the chamber by a pump 
worked by steam. An arrangement attached to the 
apparatus afforded egress to the air expired by the 
patients. Each sitting lasted two hours, the requisite 
pressure was produced gradually during the first half 
hour, and after being continued for an hour, was gradu- 
ally withdrawn during the last half hour. 

Inhalation of Oxygen Gas. 

Dr. Bricuetau (Bulletin Generate de Therapeutique 
Feb. 25, 1866 ; also, Brit, and For. Med. Chir. Rev., 
Oct. 1866, p. 532) relates some of his experience with 
the inhalation of oxygen gas. He uses an India-rubber 
bag furnished with a mouth-piece, which is controlled 
by a stop-cock ; and the patient taking a deep breath 
out of the bag, the quantity of the gas inhaled may be 
approximative gauged by the extent to which the bag 



184 THE INHALATION OF MEDICATED 

collapses at each inspiration. This apparatus must be 
similar to the one so much in vogue bj the dentists 
of this country for the administration of the nitrous 
oxide gas for anaesthetic purposes. To prevent the air 
of expiration from entering the bag, and thus mingling 
with the pure gas and diluting it with its products, it is 
directed that the patient close his lips, and pass the 
expiratory current through his nostrils ; or what is to 
be preferred, the India-rubber tubing may be compressed 
near the mouth-piece during the process of expiration. 

M. Brichetau considers inhalations of oxygen adapted 
to phthisical cases only under special conditions, ad- 
mitting that in diseases attended with the febrile move- 
ment, it may even act injuriously ; but that its employ- 
ment may be of service in the earlier stages of phthisis 
in patients of scrofulous or lymphatic habit, where the 
local symptoms are not well marked, and where there 
is progressive emaciation with persistent dyspepsia, a 
condition looked upon as favorable to the formation of 
pulmonary tubercles. 

Oxygen has also produced amelioration of the symp- 
toms in some cases of asthma. Its value in anaemia is 
incontestable. 

M. Demarquay (Gazette Medicate de Paris, April 
14, 1866), who has devoted much attention to the use 
of oxygen inhalations in medicine, says, in speaking of 
its therapeutic indications, that in the early stages of 
phthisis, when there is no fever, and no fear of exciting 
local action, when the patient is becoming emaciated, 
and the emaciation is increased by persistent dyspepsia, 
oxygen may have a salutary influence in modifying the 
state of constitution, and sustaining the organism. 
Asthenia is the disease in which oxygen has been given 






AIRS, GASES, AND VAPORS. 185 

by preference. Of twenty-two patients treated by 
Beddoes, ten were cured, and nine relieved. But the 
employment of oxygen in asthenia meets with numer- 
ous contraindications. Oxygen renders indisputable 
service in essential anaemia. It is specially indicated 
in that form of chlorosis of young girls which is char- 
acterized by obstinate anorexia ; in the anaemia of con- 
valescence, and in the anaemia, often severe, of newly- 
delivered females. The inhalation of oxygen is also 
successful in anaemia arising from hemorrhage or from 
fatigue, and is also a very energetic remedy in the 
debility produced by prolonged suppuration ; it stimu- 
lates the appetite, sustains the powers of the patient, 
and enables him to recover. In diabetes, under the in- 
fluence of oxygen inhalations, the quantity of sugar 
contained in the urine is remarkably diminished. 

In surgery, oxygen stimulates weak and ill-con- 
ditioned ulcers, and accelerates the production of granu- 
lations in cicatrizing wounds. In senile gangrene, as 
long as the circulation continues in the artery of the 
foot, oxygen is, according to the observations of MM. 
Laugier, Demarquay, and Maurice Raymond, the only 
remedy which, in advanced cases, affords a chance of 
recovery." (Ranking' 's Abstract, Jan. 1867, p. 200.) 

According to Demarquay's observations, oxygen when 
respired to the extent of twenty-nine or thirty quarts, 
produces little effect. Various invalids derived benefit 
from such a dose repeated daily. They observed some- 
times, a little heat in the pharynx, and a little confu- 
sion in the head, or headache ; the pulse usually rose a 
little in frequency and force, but sometimes fell ; the 
appetite improved, and there was a general sense of 
comfort and of increased energy. It does not appear to 

16* 



186 THE INHALATION OF MEDICATED 

be suited to those greatly exhausted by suppurating 
wounds, nor those in the later stages of phthisis. 

I reproduce in this place, an interesting chapter on 
this subject from Beigel [On Inhalation as a Means 
of Local Treatment of the Organs of Respiration by 
Atomized Fluids and Grases. By Hermann Beigel, 
M.D., L.R.C.P.S., &c, London, 1866, p. 69). 

" Their efficacy can be explained if applied to the 
proper cases. In all diseases in which dyspnoea forms 
one of the most dangerous consequences, no doubt can 
exist of the manner in which oxygen acts, as in dis- 
eases of the heart, for instance, in bronchitis, in asthma, 
emphysema, and more especially in phthisis. Here a 
part or parts of the lungs are impermeable to the air. 
But the body requires a certain amount of oxygen (an 
adult about 23,000 cubic centimetres, or 34 grammes, 
per hour) for the purpose of decarbonization of the 
blood, without which its existence is either impossible 
or very much disturbed. The diseased lungs are, there- 
fore, forced to counterbalance by the number of respira- 
tions what, in a healthy state, they would have done by 
the greater capacity of the same. Hence, respiration 
in individuals laboring from a disease which impairs 
healthy breathing, becomes irregular, difficult, frequent, 
which frequency in lung diseases is in close relationship 
to the area of the lungs that became impermeable. 
Now if we assist the lungs in their unnatural labor, by 
giving them either pure oxygen, or such an atmosphere 
as contains a greater amount of that gas than usual, 
or, in other words, if we assist the decarbonization of 
the blood in a manner which does not force the lungs 
to perform such an exhausting exercise, we place the 
patient in the best possible position. In diseases of the 






AIRS, GASES, AND VAPORS. 187 

heart the same takes place, with the difference that im- 
perfect circulation of the blood is the cause of its being 
insufficiently decarbonized. 

"After Priestley had detected oxygen, and Beddoes 
and Davy had begun to treat patients by means of that 
gas, the fate of oxygen was the same as it is of all medi- 
caments which were considered to possess such proper- 
ties as to cure almost every disease. Medicaments of 
that kind do not exist and cannot exist, and disappoint- 
ment has always been the result of such assumptions ; 
but then the fault is generally made in the other ex- 
treme direction, namely: the conclusion is then drawn, 
that because the respective medicament did not cure all 
diseases, it does not possess healing properties at all. 

" Neither of those ways is the path science studies, sep- 
arately and minutely examining every action and prop- 
erty of a body, accepting that which is found to be 
useful, and rejecting that which has proved useless. 

"From this point of view we must admit that inhala- 
tions of oxygen, pure or mixed with air, are an agent 
highly valuable in diseases, in which imperfect decar- 
bonization of the blood takes place, — be it by imper- 
meability of some parts of the lungs, be it by imperfect 
circulation of the blood, by closure of the glottis, by 
admixture of poisonous substances to the blood, or other 
causes. 

" It is not long since the application of compressed air 
in certain diseases of the chest has been recommended, 
and Berton, Junod, Tabarie', and Pravaz have endeav- 
ored to show it to be the most effective remedy in such 
affections. Now, Dr. Lange has gathered all facts hith- 
erto known in connection with the subject, and maintains 
that the efficacy of the compressed air principally rests 



188 THE INHALATION OF MEDICATED 

upon the blood being more richly supplied with oxygen, 
and that a healthier nutrition is the immediate conse- 
quence of it. He proves that by the application of 
compressed air, a considerable increase of the negative 
pressure of inspiration and of the positive pressure of 
expiration takes place, whereby the power of the muscles 
of inspiration becomes greater, the pressure of the blood 
in the aortic system is lowered, and the frequency of 
the heart's pulsation diminished. The animal heat 
lowers likewise after the application of a compressed air 
bath, the organs of digestion are placed in a better posi- 
tion, whilst the appetite increases, and the functions of 
the bowels are performed with greater ease. Increase 
in secretion of the urine has been observed in most of 
the cases. 

" It has generally been thought that pure oxygen can- 
not be inhaled without injury to health ; but Demarquay 
and Leconte have shown that they, as well as their 
friends, could readily inhale from twenty to thirty litres* 
without suffering any injury, and Ducroy has stated in 
the Academy of Paris, that pure oxygen, contrary to 
the general belief, can be inhaled for several hours with- 
out being detrimental to health ; that its action is an- 
tagonistic to that of chloroform ; that it is a powerful 
remedy for the disagreeable accidents arising from chlo- 
roform and other anaesthetics ; and that in asphyxia from 
poisonous gases — as, for instance, from carbonic acid — 
it exercises likewise a beneficial influence. Ducroy, there- 
fore, proposed to make every patient, awakening from 
a chloroform-narcosis, inhale oxygen, in order to rid him 
of headache and other inconveniences following the ad- 

* A litre is 1.0567 quarts. 









189 



ministration of that anaesthetic. According to the re- 
ports of different authors, it should be a rule, whenever 
chloroform is administered to have the oxygen-inhaler 
ready for use. 

"In compliance with the foregoing remarks, Mr. Erich- 
sen, in his ' Monograph on Asphyxia,' says : 'In a 
considerable number of experiments that I have per- 
formed on this subject, I have never succeeded in re-ex- 
citing the contractions of the ventricles by means of the 
inflation of the lungs with common air, provided they 
had fairly ceased to act before artificial respiration was 
set up.' He was then led to try oxygen, and in several 
instances was successful in restoring the action of the 
ventricles after the entire cessation of the heart's action. 

" Most interesting are the experiments made by Bed- 
does, whereby it was clearly shown that animals drowned 
and kept in water till death had apparently occurred, 
soon recovered in the free air, when, previous to their 
being drowned, they had inhaled oxygen ; while others 
which had not, died. The same result was obtained 
with animals put into mixtures which produce a very 
low temperature. Those which had previously inhaled 
oxygen could for a long time remain in such mixtures, 
whilst others were frozen to death ; others, again, were 
exposed to an atmosphere of hydrogen, and kept therein 
until entire cessation of respiration. Those treated 
previously by oxygen soon recovered when brought into 
the air, whilst animation could not be restored in the 
others. 

" But to return to our theme, viz., the application of 
oxygen, it has proved to be of great value in cases in 
which insufficient oxidation, or an abnormal composition 
of the blood, forms a prominent symptom; as in asthma, 



190 THE INHALATION OF MEDICATED 

in the more advanced stages of consumption, in chronic 
bronchitis, anaemia, Bright's disease, chlorosis, and 
other similar affections. Inflammatory stages of phthi- 
sis, inflammatory conditions of the respiratory organs 
in general, contraindicate the application of oxygen. 
It need not be mentioned that an alternately-combined 
treatment of oxygen and atomized fluids sometimes will 
render better services than either of them exclusively 
applied, as will be seen in many cases to be reported on 
in the second part of this treatise. 

" It remains now for me to make a few remarks on the 
apparatus I use for the administration of oxygen gas, as 
well as for the inhalation of volatiles, &c. It differs 
from the inhalers hitherto constructed, not only in shape 
and finish, forming a fine ornamental vase, but tends 
also to remedy some inconveniences connected with other 
similar apparatus. The patient was hitherto, after each 
inspiration, either obliged to turn his face from the ap- 
paratus, in order to perform the expiration, or to expire 
into the apparatus, whereby the oxygen became mixed 
with the expired air. 

" The only apparatus which tried to avoid this incon- 
venience is that of Dr. Richardson. But the mouth- 
piece of his apparatus, covering very inconveniently the 
patient's mouth and nose, is not only rather clumsy, but 
the valves which were intended to regulate the inspira- 
tion and expiration, soon became rolled up and never 
acted, or in a very insufficient manner only. 

"The following section of the mouthpiece of my inhaler 
(Fig. 11) sufficiently explains its construction. The two 
valves (A and B) are made of vulcanite, and, acting ex- 
tremely easily, close and open with great precision. It 
is obvious that the inhalation of the oxygen with each 



191 



inspiration — during which the valve B gets closed — 
takes place in the direction of the arrow at A ; while, 




during expiration, A closes, and the expired air escapes 
in the direction of the arrow at B. 

" In respect to the production of oxygen gas, it is now 
quite cheap enough as to be used by almost every patient. 
Hitherto, Messrs. Robbins & Co.'s oxygenesis has been 
frequently used. But though a quantity of the gas 
could readily be obtained by it in a short period, two 
things prevented the preparation from being generally 
applied, namely : its price, and the necessity of placing 
into the patient's hand a quantity of sulphuric acid. 
But these impediments do no longer exist, since Messrs. 
Robbins & Co., recently manufacture another prepara- 
tion, which is distinguished by its cheapness and by the 
large amount of oxygen which can be produced by it, 
as well as by the great ease and simplicity with which 
the evolution of the gas can be carried on by the patient, 
it being only necessary to put the powder into the in- 
haler and to pour hot water over it ; the gas then imme- 
diately escapes, and can be inhaled through the mouth- 
piece. Thus no obstacle to the general application of 
oxygen in appropriate cases any longer exists." 

Early last year I procured from London one of Dr. 



192 THE INHALATION OF MEDICATED 

Beigel's inhalers and a quantity of Robbins & Co.'s 
oxy generator, as the powder furnished by them is called. 
Inasmuch as its importation into this country makes it 
rather expensive, I requested the importers to ask for 
the formula for its manufacture, but this courtesy was 
refused by the manufacturers. I think it is composed 
of chloride of lime, with a small quantity of the peroxide 
of cobalt, the reaction upon the application of heat being 
the same as that of nitric acid in the formation of sul- 
phuric acid. I have seen it mentioned somewhere, that 
a solution of the chloride of lime, with a trace of the re- 
cently-prepared peroxide of any metal, will give off oxy- 
gen upon the application of heat, leaving, after the reac- 
tion, nothing but chloride of calcium and water. A 
portion of this powder was examined by Prof. R. E. 
Rogers and Prof. Rand, of this city, who confirmed the 
statement of Dr. Beigel as to the prompt evolution of 
oxygen gas, and my supposition as to the constituents 
of the powder. The amount of gas given off is about 
equal in volume to that procured from chlorate of po- 
tassa by the ordinary method of heating in a retort. 
Drs. Barton and Leffman, chemical assistants in Jeffer- 
son College Laboratory, examined a specimen of this 
powder, and found it to contain oxide of cobalt in small 
quantities, and unequally distributed throughout the 
mass. 

It would certainly be desirable if some enterprising 
chemists would manufacture the compound in this coun- 
try, so that it would be cheap enough to come into gen- 
eral use. Oxygen inhalations could then be resorted to 
as readily as inhalation of any of the volatile articles of 
the materia medica, the evolution of the gas ensuing im- 
mediately upon the addition of boiling water. 



AIRS, GASES, AND VAPORS. 193 

A rough method of impregnating the atmosphere with 
oxygen gas extemporaneously, is to throw some chlorate 
of potassa upon live coals ; but of course this method is 
much inferior to one by which the gas can be collected. 

My own experience with oxygen gas as a therapeutic 
agent has been thus far exceedingly limited. I have 
employed it in a number of cases of imperfect aeration 
of the air-cells of the lungs from deficient inspiration, 
and with decided benefit, but I am not prepared to 
state the benefit was not entirely due, — as it was in 
great measure due, certainly, — to the mechanical effect 
of the inhalation expanding the air-cells by forced in- 
spiration, for in the fine weather of spring and summer 
I have seen results fully as satisfactory from regular 
deep inspirations of fresh air ; the patient seated in the 
open atmosphere, or before an open window, and tak- 
ing deep inspirations slowly, while an attendant forces 
the shoulders backwards so as to assist the expansion 
of the chest during the effort of inspiration. From four 
to eight such efforts are sufficient at a time to begin 
with, and may be repeated twice a day. In cases 
where there is a sense of oppression in the upper por- 
tions of the chest from inefficient expansion, the relief 
given by these movements is prompt and decisive. 

I feel free to record that in one case of undoubted 
incipient phthisis, by which I mean a case of impaired 
respiration, in which the general symptoms and the 
family history strongly pointed to the onset of pulmo- 
nary tuberculosis, but in which there were as yet no 
positive physical signs of the disease other than im- 
paired respiration, and extreme dyspnoea at the first 
institution of the mechanical exercises above mentioned, 
the inhalation of oxygen gas, has certainly, for a time 

17 



194 THE INHALATION OF MEDICATED 

at any rate, warded off the threatened disease, and 
given the patient renewed vigor, as evinced by increase 
in nutrition, renewal of vital buoyancy, and restored 
powers of physical endurance. Of course, it is impossi- 
ble to say determinately that this case would have been 
one of phthisis, for when any threatened disease is early 
arrested, or aborted, the pathological evidences of cor- 
rect diagnosis are lost. 

The inhalation of oxygen has been tried in Europe 
for scarlet fever, but I am unable to do more than men- 
tion the fact. 

Dr. Wittmeyer, of Nordhausen {Deutsche Klinik, 
Oct. 13, 1866, p. 866), has suggested the inhalation of 
oxygen, and of the vapor of water in the stage of 
asphyxia in cholera. He is led to the employment of 
these inhalations because the functional activity and 
absorbent powers of the alimentary canal being im- 
paired, and hypodermic injection having failed, there 
remains open to us but the respiratory tract by which 
to convey remedies to the system at large. He con- 
siders two indications highly important in this stage of 
cholera ; the first being to convey water to the thick- 
ened blood ; for which purpose he proposes that the 
patient shall inhale steam and hot water nebulized from 
one of Siegle's apparatus, the temperature of the nebu- 
lized water being kept sufficiently warm by a flame 
under the medicine-glass ; then, he contends that as 
the thickening of the blood impedes the interchange of 
the gases in the lungs, the second indication is to con- 
vey oxygen to the blood, which is best accomplished by 
inhalation of the pure gas, which he maintains would 
have a more promptly excitant action upon the heart 
than any ordinary medicine which could be adminis- 



AIRS, GASES, AND VAPORS. 195 

tered in another method ; and as a result, the blood 
would be enabled to circulate through the vessels more 
rapidly, and become better and better prepared to imbibe 
the desired amount of vapor of water and of oxygen. 

Dr. Jutte, of Stettin (Deutsche Klinik, Dec. 1st, 
1866, p. 436), commenting on the article of Dr. Witt- 
meyer, says that he had made the experiment of ad- 
ministering oxygen by inhalation to four adult patients 
during the short and severe epidemic which prevailed 
in and about Stettin in the year 1856; and that the ad- 
ministration had been conducted with great care, and 
with sufficient frequency ; but that all of his patients 
died without evincing the least sign of even temporary 
improvement, and he was so disappointed with the re- 
sult that he did not pursue the experiment any further. 

This idea of Dr. Wittmeyer is, however, not entirely 
new, at least as far as regards oxygen inhalations in 
cholera, though, as far as I know, the suggestion of the 
inhalation of the vapor of water under such circum- 
stances, is entirely original. 

In the " Reports on Asiatic Cholera in the Madras 
Army, from 1828 to 1844, by Samuel Rogers. London, 
1848," the inhalation of oxygen is spoken of favorably. 

The inhalation of Oxygen as an antidote in narcosis 
has received recommendation from other sources than 
those already mentioned incidentally. 

Thus (Ranking* s Abstract, vol. 5, 1847, p. 332), under 
the impression that the specific effects of ether vapor 
upon the system are due to its power of producing a 
state analagous to asphyxia, it has been suggested by Dr. 
Jackson, and subsequently by Mr. Richardson, that 
oxygen should be kept ready to be inhaled in case of 
the occurrence of formidable symptoms, and Mr. Hooper, 



196 THE INHALATION OF MEDICATED 

acting on the suggestion, has supplied his inhaler with 
the means of furnishing oxygen at pleasure. 

The following case is related {Ranking s Abstract, 
vol. 17, p. 118, from the Canada Medical Journal, 
Jan. 1853) in support of the idea that the inhalation of 
oxygen might be very beneficial in the asphyxia caused 
by chloroform and carbonic acid, or by drowning. " A 
young man attached to the laboratory of the New York 
Medical College," writes the late Dr. Simeon Abra- 
hams, "became asphyxiated from the inhalation of the 
vapor of chloroform ; and so far had its effects been 
carried, that he became pulseless, and all hopes of his 
resuscitation abandoned; and as all the usually recom- 
mended remedies had been tried without success, noth- 
ing but the death of the young man was looked for, 
when I proposed, as a dernier ressort, the application of 
pure oxygen gas as the only chance by which resuscita- 
tion could be brought about ; but, at the time, the pro- 
posal met with opposition from the medical men present, 
who were anxiously watching what seemed to be the 
expiring efforts of the poor boy, expecting each moment 
to be his last. Having, however, consented, the gas 
had not been more than a few seconds applied to his 
nostrils, when he who was apparently beyond the help 
of human aid, and absolutely in articulo mortis, arose 
and placed himself upon a chair, proving most conclu- 
sively how correct I was in proposing the application of 
oxygen gas as a remedy against the deleterious effects 
of chloroform as an anaesthetic." 

Dr. Beigel (op. cit., p. 104) considers the adminis- 
tration of oxygen gas particularly applicable to the 
suffocative paroxysms of croup, not for the purpose of 
curing the disease by the inhalation of oxygen, but to 



AIRS, GASES, AND VAPORS. 197 

guard the patient from the consequences of such attacks, 
which frequently prove fatal, and to place him in such 
a position as to enable us to apply other remedies ; 
oxygen, under such circumstances, having in some meas- 
ure the same effect as tracheotomy, whereby we intend 
to evade a particular part of the respiratory tract, in 
order to gain time till we possibly master the inflam- 
mation, as well as the formation of the pathological 
products represented by the croupal membranes. 

As an illustration of this fact, Dr. Beigel reproduces 
(p. 105) the following' case, reported by Miquel (Cor- 
respondence Blatt des Vereins filr Gemeinschaftliche 
Arbeiter, 1862) : 

" Severe case of croup; application of the usual medi- 
caments without benefit. Immediate alleviation after 
oxygen had been inhaled. — The patient was a boy 
twenty-one months old, hitherto perfectly healthy. 
On February 21, 1862, Miquel was summoned, and 
found the child in the following condition : Breath- 
ing, noisy and whistling, short, some fifty respirations 
in the minute, but irregular, as well in respect to 
the rhythm as to duration ; pulse small, very fre- 
quent, impossible to be counted ; countenance pale, 
lips livid ; all muscles are active during breathing, 
and the regular movements of the levatores alse nasi, 
of the muscles of the throat, &c, were combined with 
irregular spasmodic movements, which now and then 
agitated the face. The little patient frequently bent 
his head quite backwards, the expression of his counte- 
nance being very anxious, and seized his throat convul- 
sively with his hands. His face was moist and cold. 
The child very seldom yet made efforts to cough ; when 
coughing, the voice appeared barking, hoarse, sup- 

17* 



198 THE INHALATION OF MEDICATED 

pressed. According to the report of the house doctor, 
nine days ago the child was seized with symptoms of 
croup, which at first decreased by emetics, leeches, and 
other remedies, but three days ago have recurred with 
great intensity. The usual remedies were applied again, 
but failed to do any good, and a newly administered 
emetic was to the same effect ; involution of the legs in 
mustard powder, and inhalations of hot steam, were 
vainly resorted to. At half-past ten, inhalations of 
oxygen were tried. One cubic foot of that gas, one 
volume of pure oxygen mixed with a smaller portion of 
atmospheric air in a gasometer, was brought to the 
patient's residence. The amount of respiration might 
have been about five cubic inches, the quantity of gas 
(1728 cubic inches) was, therefore, sufficient for 350 
inspirations, which might have been performed in about 
nine or ten minutes, yet the procedure lasted about fifteen 
to twenty minutes. The child's condition after the in- 
halation was the following : pulse perceptible, less fre- 
quent, number of respirations about the same. The ap- 
pearance of the child was, according to the judgment of 
all persons around him, more quiet, less anxious ; patient 
became more reactive to the impediment to respiration, 
so that he coughs frequently, though with the peculiar 
croup sound ; once such a cough spontaneously pro- 
duced vomiting. The spasmodic movements of the 
muscles of the face, as well as of other regions of the 
body, ceased, and at one o'clock in the morning the 
parents came to me to report that the child had slept 
very quietly, and that the spasm and anxiety had dis- 
appeared. They added that on no previous night the 
suffocating seizures and the expression of the counte- 
nance were so alarming ; but that on none of the four 






199 



previous nights was the patient so quiet as he is to- 
night. On the following morning the child was found 
to be still better, and though the oppression recurred 
on the following evening in a slight degree, yet all the 
remainder vanished by medicaments applied for the 
disease itself, and the patient recovered entirely." 

Beigel relates the details of several cases under his 
own care, treated by alternate inhalations of oxygen 
and of nebulized fluids. 

One of these (op. cit., p. 114) was advanced diph- 
theria in a child six years of age, which was cured by 
the inhalation of oxygen gas, one gallon morning and 
evening, and the inhalation of a solution of the tincture 
of the chloride of iron, ten minims to the fluid ounce of 
water ; a remarkable alteration in the patient's condi- 
tion being perceptible after the first inhalation of oxy- 
gen. Also (op. cit., p. 116) a very severe case of diph- 
theria after small-pox, with exudation lining the whole 
pharynx, laryngeal implication, suffocative paroxysms, 
&c. The patient, a boy ten years of age, was seen by 
Dr. Beigel on the fourteenth day of the illness, after 
the administration of calomel for six days had afforded 
no relief. This case was treated by inhalations of the 
spray of hot water, afterwards of lime-water, and sub- 
sequently of tannin ; oxygen being administered to re- 
lieve the suffocative attack with complete success, and 
being continued twice a day as long as requisite ; the 
combined treatment resulting in a cure. 

It will be remembered that in Lewin's fourteenth 
case of diphtheria (see p. 131), oxygen inhalations were 
resorted to in addition to the other treatment. 

Beigel also relates (op. cit., p. 133) a severe case of 
asthma, in which the suffocating attacks were sup- 



200 THE INHALATION OF MEDICATED 

pressed by inhalations of oxygen ; this case and several 
others, detailed in succession, having been cured by the 
alternate inhalations of oxygen and of Fowler's solu- 
tion of arsenic. He also details a case of emphysema, 
and one of chronic laryngitis with suffocative parox- 
ysms, in which oxygen inhalations were productive of 
great benefit. 

Beigel believes that in children predisposed to phthisis, 
the inhalation of oxygen gas would delay, or even pre- 
vent the outbreak of the disease ; and that even after 
the development of the affection, inhalations of oxygen 
gas sometimes render astonishing services. In proof of 
this he details a case (op. cit., p. 182) in which an en- 
gineer, twenty-three years of age, of scrofulous diathe- 
sis, with tuberculous infiltration of the left apex, and 
bronchial catarrh of the right lung, with haemoptysis, 
colliquative perspirations and rapid loss of flesh, was so 
much improved by the inhalation of a gallon of oxygen 
twice a day, and of a solution of the sesquichloride of 
iron twice a day, that in a little less than five months, at 
which time the treatment was discontinued, the patient 
could hardly be recognized as the same man ; he had 
grown strong and muscular, and but that dulness re- 
mained at the left apex, he could be considered perfectly 
healthy. He was seen a year afterwards by Dr. Beigel, 
whom he assured that he had enjoyed very good health 
during the whole of that period. 

Inhalation of Nitrous-Oxide Gas. 

The inhalation of nitrous-oxide (laughing-gas) has 
been employed pure, for the purpose of supplying the 
system with a large amount of the oxygen it contains, 
and in the same affections for which oxygen has been 






AIRS, GASES, AND VAPORS. 201 

recommended, such as anaemia, incipient phthisis, &c; 
and, it appears, equally applicably. It is now prepared 
extensively in all our large cities as an anaesthetic for 
dental purposes, and can thus be readily procured by 
those who wish to try its efficacy. 

Surgeon George G. Shumman, United States Volun- 
teers, reports (Am. Med. Times, 1863, pp. 28 and 38) 
a number of cases (14) of typhoid fever, also two of 
measles, and one of 'erysipelas, in which inhalations of 
the nitrous-oxide gas were administered at the stage of 
prostration for the purpose of supplying oxygen to the 
system, with beneficial results in all cases ; even in some 
which proved fatal, for life had been apparently prolonged 
many hours by this means, although insufficient to stimu- 
late to the point of recuperation. Some of these cases 
which recovered, had been pronounced hopeless, and all 
of the patients are reported as having expressed them- 
selves as feeling much the better for the inhalations. 
Attention is called to the resort to this method in the 
prostrated stages of cholera and other affections. 

Whether it acts by supplying oxygen is a question. 
Other compounds of oxygen and nitrogen containing 
a much larger proportion of oxygen, are, as* is well 
known, extremely deleterious when inhaled. It is 
quite probable that the nitrous oxide has an influence 
as such; because we know that the action of chemical 
compounds is often different to what would be inferred 
from a knowledge of the effects of their constituents. 

Inhalation of Vapors of Chlorine. 

Chlorine may be inhaled by adding water to chloride 
of lime in a Wolfe's bottle or other inhaler. 

It has been asserted that paper-makers, though ex- 



202 THE INHALATION OF MEDICATED 

posed to the fine dust from the rags, &c, are, as a class, 
peculiarly exempt from phthisis, and on account of their 
exposure to the fumes of chlorine ; and it is probable 
that this circumstance gave origin to its suggestion as a 
remedial agent by inhalation. 

Gannal, observing that workmen in a bleaching es- 
tablishment, who suffered under diseases of the chest, 
were visibly improved, ascribed the amelioration to the 
inhalation of air containing this gas, and was led to in- 
stitute experiments upon consumptives, with good re- 
sults. Sir James Murray is reported [Dub. Jour. Med. 
Set., March, 1839), to state that a friend had observed 
similar beneficial effects among his workmen from ex- 
posure to the inhalation of a watery vapor strongly im- 
pregnated with this gas. 

Louis reported that in a number of experiments on 
consumptive patients at LaPitie', L'Hotel Dieu, &c, he 
had not obtained any successful result from the inhala- 
tions of chlorine gas; though he has elsewhere admitted, 
with M. Cottereau, that singular advantage may be ob- 
tained from chloruretted inhalations in certain cases of 
chronic bronchitis, even where the general symptoms 
closely resemble those of phthisis. 

Dr. Stokes found these inhalations prejudicial in 
phthisis, being too provocative of irritation, though he 
found them beneficial in correcting fetor in gangrene of 
the lungs. Dr. Elliotson found them secure greater ame- 
lioration than narcotics or any other means then em- 
ployed ; and many others have confirmed this result. 

Dr. A. T. Thompson considered chlorine (Dungli- 
son's New Remedies, 7th edit., p. 200) the best topical 
expectorant, and the most salutary excitant to the mu- 
cous membrane that had yet been inhaled. 



AIRS, GASES, AND VAPORS. 203 

Sir Chas. Scudamore tried chlorine in several in- 
stances of phthisis, but found it inferior to iodine. 

Dr. 'Elliotsox (Lancet, 1830-1, vol. 11, p. 198) found 
great mitigation from inhalation of chlorine in two cases 
of phthisis. 

" A remarkable case of consumption, of the worst 
kind, cured by inhalation of chlorine," is reported by 
Dr. Cottereau (Lancet, 1830-31, vol. 11, p. 169, from 
the Journal Hebdomadaire), in which, some two years 
after being cured of his consumption, the patient died 
from acute inflammation of the mucous membrane of 
the stomach and small intestines, without any derange- 
ment of the respiratory system ; and the post-mortem 
examination showed the old cicatrices, and some crude 
tuberculous granulations. Twelve more cases, in which 
all the physical signs were decisive of phthisis, and in 
which recovery ensued under inhalations of chlorine, are 
recorded by Dr. Cottereau in Arch. Gen. de Med., ^No- 
vember, 1830. 

In cases of poisoning by hydrocyanic acid, as well as 
by sulphuretted hydrogen, the inhalation of chlorine is 
a most efficient agent. Chlorinated lime may be used 
for this purpose. (Dunglisoii s New Remedies, 7th ed., 
p. 202.) 

Prof. Dunglison considers the inhalation of chlorine 
adapted only to cases of disease in which the pathologi- 
cal condition of . the bronchial mucous membrane or 
neighboring parts, requires the exhibition of an excitant. 
In this way it may be occasionally serviceable in chronic 
bronchitis. (Materia Medica, 4th ed., p. 257.) 

The gas, in proper dilution for inhalation, may be 
evolved by mixing one or two drachms of the chlorine- 
water with a couple of ounces of hot water, and placing 
the vessel in a hot bath, or over a flame. 



204 THE INHALATION OF MEDICATED 

Dr. Corrigan (Bunglisons New Remedies, 7th ed., 
p. 201, with figure) devised an apparatus for this pur- 
pose, fulfilling the following requisites : Firstly, That 
the apparatus should be simple in its construction and 
easily kept in order ; Secondly, That it should be capa- 
ble of keeping up a supply of vapor for any length of 
time, and that the evolution of the vapor should be 
steady and easily regulated ; Thirdly, that it should 
also furnish a sufficient supply of aqueous vapor, to pre- 
vent any irritation of the larynx, or lining membrane 
of the air-tubes ; and, Fourthly, and most important of 
all, that its employment should entail neither trouble 
nor fatigue on the invalid. This apparatus consists of 
a light, open, iron-wire frame, about eighteen inches 
high, at the bottom of which is a spirit-lamp ; at the 
proper height above this is an evaporating porcelain 
dish, about six inches in diameter ; and above this is a 
glass globe, with its neck downwards. In the neck of 
the globe is a cork, bored, and through the opening is 
drawn, moderately tight, a short plug of cotton wick, 
such as is used in a spirit-lamp ; in the glass globe, 
opposite the neck, a pin-hole is drilled, to allow air to 
pass in, according as the fluid within drops out through 
the neck. To use it, the porcelain dish is filled with 
hot water, the spirit-lamp is lighted, and as soon as the 
water in the dish has begun to boil, the glass globe con- 
taining chlorinated lime (if this be the substance used), 
is placed in position. The rate at which the fluid in 
the globe shall percolate the cotton wick and drop into 
the hot water beneath, is easily regulated. If it should 
not drop with sufficient rapidity, one or two of the 
threads of cotton may be removed. Should it drop too 
rapidly, this is corrected by pressing in the cork more 



205 



tightly, or introducing one or two additional threads of 
wick. 

Eight ounces of a saturated solution of chlorinated 
lime may be poured into the glass globe ; and into the 
water of the porcelain dish, two ounces of the diluted 
sulphuric acid of the Pharmacopoeia. As the solution 
drops, the acid seizes on the lime, and the chlorine is 
evolved in connection with aqueous vapor. 

Prof. Jos. Pancoast, of Philadelphia, reports ( Trans. 
Am. Med. Ass'n, 1850, vol. iii, p. 135) the cure of a 
particular form of aphonia by means of the inhalation 
of the vapor of chlorine. The form of aphonia is that 
inferred to be due to partial paralysis of the intrinsic 
muscles of the larynx. 

As an inhaling apparatus, Dr. Pancoast used the 
ordinary tubulated glass retort of the chemist, with a 
glass funnel having some filtering paper at the bottom. 
In the bowl of the retort he placed a solution of the 
chloride of soda, or lime. Into the glass funnel was 
put a weak solution of muriatic acid in water. As the 
dilute acid fell drop by drop into the bowl of the retort, 
chlorine was very gradually liberated and breathed 
from the end of the instrument. 

In using this apparatus, some care is required that 
the acid solution should not be allowed to drop too 
freely on the salt in the bowl of the retort, so as to de- 
velop the gas too freely. But the patient has the means 
of protecting himself against too strong an impression 
of the chlorine on the glottis, by diluting it with air 
drawn in through the nostrils, a measure to which he 
would instinctively resort. 

The first case in which this method was employed, 
was a healthy young country girl, who had contracted 

IS 



206 THE INHALATION OF MEDICATED 

a severe cold by remaining in a damp spring-house. 
The aphonia had lasted for six months, resisting every 
sort of treatment. 

She was placed upon the inhalation of chlorine, con- 
tinued for some minutes, and repeated two or three times 
a day, according to the degree of irritation it produced 
in the throat and larynx. From the first trial, the pa- 
tient's voice improved, and in three days had become 
very nearly as strong as ever. A couple of months 
after her return to the country, another cold was fol- 
lowed by a similar case of aphonia. The patient again 
breathed the dilute chlorine vapor for a few times, and 
had her voice restored. 

The second case was that of a well-known practi- 
tioner whose voice had been lost for about seven months, 
so that he was unable to practice his profession. Besides 
exhausting the more ordinary means resorted to in these 
cases, he had made, without any good effect, repeated 
trials of a strong lunar caustic solution, applied with a 
sponge to the glottis. 

His voice began to improve from the first trial of the 
chlorine. The improvement was steady, but more slow 
than in the case above detailed, a week or ten days 
elapsing before his voice was restored to its natural 
strength. 

Dr. Pancoast considers that the chlorine acts merely 
as a local stimulant, and that iodine, or any other excit- 
ing vapor would effect similar results. 

Inhalation of Vapors of Iodine. 

The close resemblance between tuberculosis and 
scrofulosis, and the well-known alterative effects of 
iodine upon diseases of the latter character, especially 






AIRS, GASES, AND VAPORS. 207 

as they affect the lymphatics and other glands, readily 
led to the employment of the same remedy in pulmo- 
nary consumption ; and the volatile nature of iodine 
suggested its employment by inhalation, for the treat- 
ment of affections of the respiratory organs. This 
vapor has been found of decided efficacy in confirmed 
phthisis, and in certain forms of catarrh, by Berton, 
Sir James Murray, Baudelocque, Huette, Chartroulle, 
Lugol, Chomel, Laennec, Piorry, Dechambre, Corri- 
gan, Scudamore, and many other well-known authori- 
ties. 

Piorry read a paper on the subject of the treat- 
ment of phthisis by iodine inhalations, before the 
Acaddmie de Me'decine (Comptes Rendus, Jan. 24, 
1854, see Ranking s Abstract, vol. 20, p. 70) [Archives 
Generates de Me'decine, March, 1854, p. 361), in which 
he treats of it in very high terms. M. Piorry, after 
mentioning the circumstances inducing him to employ 
inhalations of iodine in the treatment of phthisis, says 
that the results of the experiments, instituted by him- 
self in conjunction with M. Deyne, an interne of his 
service, were very satisfactory. A striking ameliora- 
tion took place in many of their patients, which amelio- 
ration was permanent, inasmuch as several patients, 
mentioned in his work on Practical Medicine, were 
still in the enjoyment of good health. 

The successful treatment of hydrocele and tubercu- 
lous diseases of the testicle, by injections of solutions 
of iodine, led to the inference of obtaining similar bene- 
fit in pulmonary excavations, but the difficulty, not to 
mention the temerity, of attempting the injection of 
tincture of iodine into a pulmonary cavity, or into the 
air-passages, led to the plan of employing the vapor of 



208 THE INHALATION OF MEDICATED 

iodine. Sometimes the crystals of iodine were em- 
ployed to evolve the vapor, and sometimes the tincture 
of iodine was used. In the former instance, two or 
three scruples of iodine were placed in a wide-mouthed 
quart jar, from which the vapor would be disengaged 
spontaneously with greater or less rapidity, according 
to the temperature and humidity of the atmosphere. 

In other cases, one to three ounces of the tincture of 
iodine were poured into the jar, which was then heated 
until the vapors of iodine and alcohol were given off. 
The patients breathed the vapors, taking one deep 
sighing inspiration at a time, and repeated the effort 
from one to two hundred times daily, at appropriate 
intervals, several successive inspirations producing pain 
in the larynx and bronchi) with cough, although the 
single inspirations did not produce much irritation. 

With Laennec, who surrounded the bed of his con- 
sumptive patients with the varec, in order to procure 
the iodinized vapor, Piorry, too, employed inhalations 
of iodine during sleep. He placed several saucers con- 
taining iodine about the patient's pillow, or attached a 
number of vials of iodine to the bedposts, so as to satu- 
rate the air with iodine, which is given off in sufficient 
quantity to blue any starched curtains that may be 
about the bed. 

Piorry calls attention to the circumstance, that if a 
moist starched paper is interposed between the vessel 
from which the vapor is being liberated, and the pa- 
tient's mouth, as he takes an inspiration, it turns blue, 
while the same air breathed upon the paper, after 
having traversed the lungs, causes no change; from 
which fact he infers, that the iodine which enters the 
lungs is absorbed there. 






AIRS, GASES, AND VAPORS. 209 

The treatment of Piorry's cases was not confined to 
the iodine inhalations. Most of them took from twenty 
to sixty grains of the iodide of potassium by the stom- 
ach daily. In cases of supposed adhesions, frictions 
were resorted to with tincture of iodine, one part to 
nineteen parts of water. Other remedies, as astrin- 
gents, opiates, and other narcotics, quinine, &c, were 
given to fulfil various indications ; while a nutritious 
and reparative diet was employed, to which regimen 
Piorry gives a preference over all the remedies em- 
ployed, except the iodine. 

Thirty-one patients were thus treated during a period 
of two years, all presenting in different degrees un- 
mistakable signs of phthisis, with the characteristic 
sputa, and positive plessimetric and stethoscopic evi- 
dences of the disease. 

In order to determine with precision the effects of 
the iodine, some charts were prepared, upon which were 
marked exact delineations of the parts diseased, and rep- 
resentations of the variations in sound upon percussion, 
which occurred from day to day. After periods varying 
from four, six, or twenty days, to from six weeks to 
four months of the iodine treatment, there was in al- 
most every case a diminution of the extent of the sur- 
face over which there was at first feebleness of respi- 
ration, dulness, resistance, &c, while at the same time, 
auscultation indicated an amelioration in the condition 
of the condensed portions of the lung. Numerous 
patients with cavities in the lungs were apparently 
cured. 

The ultimate results were : decided amelioration in 
the symptoms and anatomical characters in twenty 
cases ; disappearance of the anatomical characters and 

18* 



210 THE INHALATION OP MEDICATED 

of most of the symptoms in seven cases ; death with or 
without amelioration in four cases. 

M. Piorry's conclusions are as follows : 

1st. The inhalation of the vapor and tincture of iodine 
is useful in the cure of phthisis. 

2d. In many cases, such inhalation is followed by a 
diminution in the extent of the indurated parts sur- 
rounding tuberculous deposits, and an amelioration in 
the general symptoms. 

3d. It is probable that tubercle itself disappears 
under the influence of iodine inhalations. 

4th. That inhalations of the tincture of iodine may 
promote the cure of tuberculous cavities. 

5th. That after the softening of tubercles, the result- 
ing cavities may cicatrize spontaneously. 

6th. That compression of the thorax over the points 
of disease indicated by percussion and auscultation, may 
contribute to the cure of the local lesion, and to the 
prevention of pyaemia. 

7th. That iodide of potassium administered internally, 
and frictions with diluted tincture of iodine over adhe- 
rent portions of the lung, are also of great utility. 

Sir Chas. Scudamoke found the irritating qualities of 
the gas subdued by the addition of a little tincture of 
conium at the time of employing the inhalation, a higher 
heat being necessary to liberate the vapors from the 
conium than is necessary with iodine alone. 

Sir Chas. Scudamore (London Med. Gazette, February, 
1840), after ten years' experience with iodine inhala- 
tions, had acquired increased confidence in their efficacy. 
His formula at this time was 6 grs. each of iodine and 
iodide of potassium, with 2 drachms of alcohol, to 5 
ounces of distilled water, adding a little tincture of 



211 



conium at the time of mixing the solution of iodine with 
the water for inhalation. He began with a drachm or 
so of the iodine mixture, two or three times a day, in- 
creasing the dose, if necessary. 

The vapor of iodine may be inhaled from a solution 
of the tincture in water, by means of a Wolfe's bottle, 
or other inhaler, no artificial heat being necessary. 

Dr. Berton's method consisted in placing into a flask 
with two openings, some dilute sulphuric acid, to which is 
added a quarter or half a grain of the hydriodate of 
potash ; the iodine vapors are promptly disengaged, and 
are inhaled by the patient from one of the tubes from 
the flask, the process of inhalation occupying four or 
five minutes, and being repeated as often as desirable, 
even to the number of ten times a day. 

Dr. Pereira's experience in phthisis, as well as other 
chronic pulmonary complaints, has not been favorable. 

M. Simon relates {Brit. $> For. Med.-Cldr. Rev., July 
1861, from X' Union Medicale, March 16, 1861) the re- 
sults of a number of cases of phthisis pulmonalis treated 
by M. Chartroulle with inhalations of iodine, a prac- 
tice very frequent in Belgium. Under his directions, 
twenty-eight patients in the hospital were treated by the 
inhalation of the vapor of pure iodine, and of this num- 
ber only eleven could be said to have derived no benefit 
from the treatment. In these unsuccessful cases the pul- 
monary lesions were not modified, but still, the symptoms 
were not aggravated in any case. In opposition to the 
statement that iodine vapor produces haemoptysis, it was 
found that pulmonary hemorrhage ceased more rapidly 
under this kind of treatment than under other plans 
which are more generally employed. Seventeen pa- 
tients derived positive benefit from the iodine treatment, 



212 THE INHALATION OF MEDICATED 

and this improvement was observed not only in relation 
to the general symptoms, but also to the pulmonary 
lesion itself, as was proved by percussion and ausculta- 
tion. Out of the seventeen patients but four might be con- 
sidered as actually cured. One of these cases of cure is 
the following : A youth 16 years of age, entered the 
hospital in such an alarming condition that at first the 
physicians hesitated to submit him to the iodine inhala- 
tions. He was in a state of great emaciation, and his 
skin was almost constantly covered with profuse perspi- 
ration ; he had diarrhoea, which had lasted for two 
months, and he had repeatedly suffered from haemopty- 
sis. There were very extensive indurations in the lungs, 
and at the apex of the right lung there was a cavity of 
some size, as was shown by very obvious gargouillement. 
The expectoration also was characteristic. After rest- 
ing a few days, this young man was subjected to the 
iodine inhalations, and all the symptoms which had ap- 
peared so serious were soon modified in a most remark- 
able manner. The general symptoms disappeared first, 
and the body recovered its plumpness with great rapid- 
ity. The perspiration, diarrhoea, fever, cough, and ex- 
pectoration, were soon relieved or removed, and six 
weeks after admission into the hospital the patient went 
out quite well. 

Several other cases of the same nature are recorded 
from both the public and private practice of M. Char- 
troulle, and in all of them the beneficial results of iodine 
inhalations are remarkably exhibited. Dr. Simon, who 
relates the cases, attributes a great part of the efficacy 
of the treatment to the apparatus employed for inhala- 
tion, which, however, is not described in the paper. By 
this apparatus, it appears, a degree of precision is given 






AIRS, GASES, AND VAPORS. 213 

to the treatment which consequently becomes the more 
efficacious, for a close of the vapor may be estimated 
with exactness, and the remedy may be made propor- 
tionate to the severity of the disease and the strength 
of the patient. 

Lewin (op. cit., p. 202) had employed vapor of iodine 
in phthisis several times without any favorable results, 
but all his cases were in the advanced stage. 

The inhalation of iodine vapor has been employed in 
coryza. An army surgeon, M. Luc, seized with very 
bad coryza, attended by fever, severe cephalalgia, and 
excessive secretion, determined upon trying the effect of 
the inhalation of iodine vapor. The coryza first ap- 
peared at 9 A. M., and the inhalations were commenced 
at 3 P. M., being repeated every three minutes during 
an hour, each lasting about a minute. The headache 
was first relieved, the sneezing then occurring less fre- 
quently, the amount of secretion diminishing, and by 6 
P. M., all traces of the coryza had disappeared, except 
a little burning sensation in the throat. Several of the 
officers have since tried the means with the same re- 
sults. The inhalation is effected by placing a bottle of 
tincture under the nose, the hand supplying warmth 
enough to vaporize the iodine. (Rev. Med., August 31 ; 
Med. Times and Gazette, November 11, 1865 ; The Med. 
Record, March 1, 1866.) 

Dr. A. P. Merrill, of New York, formerly Professor 
of Materia Medica in the Memphis Medical College, and 
editor of the Memphis Medical Recorder, has for a num- 
ber of years made extensive use of the inhalation of the 
valors of iodine in mucous inflammations of the trachea 
and bronchi, led to the treatment by the happy results 
previously obtained in his own case and that of others, 



214 THE INHALATION OP MEDICATED 

by its local application in a convenient form, in cases 
of chronic pharyngitis and laryngitis. These cases are 
reported in the Memphis Medical Record, vol. i, 1852- 
3, pp. 8, 21, 113 ; vol. iii, 1854-5, pp. 133, 18T, 228, 
285 ; vol. iv, 1856, pp. 252, 377. 

Dr. Merrill employs the vapor disengaged directly 
from the crystals of iodine, which are sufficiently volatile 
in a current of cold air to afford all the strength of 
vapor that can be conveniently borne by the patient. I 
make a few extracts from some communications on this 
subject, kindly furnished me by that gentleman. " In 
a case of such inflammation beyond the reach of the 
brush, I found a patient inhaling the vapor of gum cam- 
phor through a common quill, but without much effect. 
I added a few grains of iodine to the camphor, and then 
the relief obtained was more decided ; but in applying 
this combination to other cases, I met with a difficulty 
in the liquefaction of the mixture, and then determined 
to use each remedy separately, by placing it within a 
small cane tube, with a little coarse wool in each end 
to prevent the escape of the medicine. I nave used 
tubes of glass, also, but found them to hold the reme- 
dies less securely. The cane tubes have answered an 
excellent purpose, whether employed through the medi- 
um of the mouth or the nasal passages, but more re- 
cently I have substituted tubes made of hard rubber, 
so rounded at the ends as to prevent irritation, and the 
vapor escapes through several perforations at the ex- 
tremity. With these tubes, which unscrew at the middle 
for the introduction of the iodine, the teeth, tongue, &c, 
are protected from any disagreeable effects of the vapor, 
and the current may be made to impinge in any desired 
direction. 






215 



" Great benefit is derived from iodine inhalations in 
the more acute affections of the nasal membranes, such 
as coryza, hemorrhage, and catarrh. They relieve the 
habitual catarrh of old people, and are advantageous to 
public speakers and singers, whose vocal organs have 
become debilitated from excessive exercise in their voca- 
tions, and which sometimes show a tendency to oedema 
of the glottis, and terminate in aphonia." 

Dr. Merrill details (Am. Jour. Med. Sci., Jan. 1866) 
an interesting case of symptomatic bronchial irritation, 
in which the iodine inhalations were very beneficial. 
These were made with tubes of cane in the manner pre- 
viously described. He considers that the iodine acts 
in chronic cases by exciting a watery secretion which 
disengages the viscid mucus which frequently induces 
coughing by its titillation, and that it relieves hyper- 
emia and hypertrophy. He has found benefit from in- 
halations of iodine vapor, in croup, in oedema of the glot- 
tis, and aphonia. 

In cases of children, and people unwilling or unable 
to inhale properly, he attaches a gum hand-bellows by 
a rubber tubing to the tubes, and thus forces the vapor 
into the nasal or laryngeal passages. 

Dr. Merrill has kindly furnished me with the follow- 
ing notes of a case of profuse bronchorrhoea, which 
was suppressed by inhalations of iodine. 

"Mrs. McL., aged 70 years, had suffered for several 
months with cough, constipation, and oedema of the feet 
and legs, with incontinence of urine. She complained 
especially of excessive expectoration, which had re- 
duced her almost to a skeleton, and it was with diffi- 
culty she could walk across the room. I did not see 
the matter expectorated, which was so offensive that she 



216 THE INHALATION OF MEDICATED 

declined saving it, but both she and her daughter esti- 
mated the quantity latterly at a pint to a pint and a 
half every morning, for it was only in the morning that 
her cough troubled her. Beginning at three to four 
o'clock, it continued several hours, during which time 
the expectoration was free and profuse, and she often 
passed the remainder of the day without coughing at 
all. 

"I gave her an inhaling-tube, charged with iodine, to 
be used frequently during the day and night, and di- 
rected her to take one-tenth of a grain of arsenious 
acid three times a day, together with half a grain of 
calomel at night. This course was continued twenty 
days with progressive improvement, when (June, 1867) 
she was entirely relieved of the bronchial disease, and 
the iodine inhalations were suspended." 

Inhalation of Nitrous Gas in Whooping-cough. 

Dr. Thomas records (Am. Med. Recorder, 1822, p. 
660) a case of pertussis of nearly three weeks' duration, 
which was cured within ten days by the inhalation of 
nitrous gas. The patient was his own son, aged be- 
tween four and five months, and he was led to the use 
of the remedy from the perusal of some cases treated 
by this gas by Mr. Patterson, in J. Carmichael Smith's 
work on Nitrous Vapor, to which his attention was 
called for the purpose by a professional friend. He 
closed every aperture of the apartment occupied by 
the little patient, which might afford exit to the gas ; 
he then placed a teacup in a sand-bath, poured half an 
ounce of sulphuric acid into the cup, to which he gradu- 
ally added half an ounce of pulverized nitrate of pot- 
assa, so as to occupy an hour each night in the disen- 



217 



gagement of the vapor. The application did not provoke 
cough, and the child usually fell asleep at an early hour. 
The treatment began on the night of July 30th, and 
after that of August 1st, there was no more whooping, 
and in ten days the child was well. Dr. Thomas con- 
cludes thus : " In the foregoing case it appears evident 
to me, and I trust it will to all those who read it,- that 
the vis medicatrix naturae had no agency in relieving 
the patient. I am willing at all times to pay due hom- 
age to that power, but not at the expense of truth and 
justice ; let us, therefore, ' render unto Caesar that which 
belongs to Caesar,' and not ascribe merit where none is 
due." 

Inhalation of Sulphurous Vapors. 

The inhalation of sulphurous vapors has been em- 
ployed from very early times. Galen, it is known, rec- 
ommended patients with various affections of the re- 
spiratory organs to frequent the neighborhood of Mount 
Vesuvius, to respire the air loaded with its sulphurous 
emanations. They were also employed by Celsus. 

Recently (Lewin, p. 4) sulphurous vapors have been 
much employed in chronic bronchitis by the French ' 
physicians, principally Pujade, of Amelie les Bains. 

Dr. Jas. Dewar (Dublin Medical Press and Circu- 
lar) speaks highly of the benefit of using the sulphur- 
ous acid fumes in the treatment of typhoid, ephemeral, 
and scarlet fevers ; in diphtheria, gout, and rheuma- 
tism. He saturates the atmosphere of the patient's 
room with the vapor. (The Medical Record, vol. 1, p. 
395.) 

The manufacture of sulphuric acid, it is asserted 
19 



218 THE INHALATION OF MEDICATED 

bf M. Baumes (Dictionnaire des Sciences Medicates) 
protects those employed against phthisis, even restor- 
ing to health those that seem to have been predisposed 
to the disease. (Coxe, On Medical Inhalation, Phila., 
1845.) 

Inhalation of Carbonic Acid in Phthisis. 

The statement of M. Gutllot {Archives G-enerales 
de Med., Jan., Feb., and March, 1845 ; Banking's Ab- 
stract, 1845, vol. i, p. 211) that the dark- colored mat- 
ter found in the lungs under certain circumstances, and 
which, according to Dr. Cakswell, is a physiological 
carbonaceous deposit due to stagnation of the blood in 
the pulmonary tissues, possesses the remarkable power 
of inducing a modification in tuberculous deposits, led 
to experiments as to the power of arresting phthisis by 
instituting inhalations of carbonic acid gas as a reme- 
dial agent. Certain Russian physicians reported favor- 
able results a few years subsequently, but the subject 
does not seem to have attracted much attention outside 
of their own country, and has most likely fallen into 
disuse there. 

The Inhalation of Illuminating Gas. 

The vapors of illuminating gas have been employed 
in cases of whooping-cough. Early in 1864, at Amster- 
dam, children with this affection were sent to the place 
of manufacture of the burning gas, and allowed to 
breathe the gaseous atmosphere for a certain period, 
with very satisfactory results, many cases having been 
considered to have been cured in this manner, and 
without injurious results in any one instance. 

The same method was employed at Calais in the 






219 



winter of 1864, during an epidemic of pertussis, a num- 
ber of children thus affected being sent to the gas-house 
to breathe the vapor at the moment of escape after sub- 
jection to the purifying process. As soon as the chil- 
dren breathed this air they began to improve, and 
thorough cures resulted. Two or three visits sufficed 
to put an end to the paroxysm of cough. 

Other investigations were made in this direction 
about the same period. Thus we see (Am. Jour. Med. 
Sci., April, 1865, p. 487, from Brit. Med. Jour., Nov. 
5, 1864) M. Commerge presented to the Imperial 
Academy of Medicine, a report on this subject drawn 
up from the observations of the effects produced on one 
hundred and forty-two children affected with whooping- 
cough, and who had been brought under the action of 
the gases in the gas-works at St. Maude. His conclu- 
sions are to the effect that the treatment produces ex- 
cellent results, and at all periods of the disorder. In 
general, twelve stances are required for the cure, and 
each seance should be of two hours' duration. However 
young the patients, no danger results from the exposure 
to the gases. Then again, we have Dr. Bertholles, 
who informs the French Academy of Medicine of the 
effects observed to result from the inhalation of the 
vapors disengaged from the remains of the materials 
used in the purification of gas, by children having 
whooping-cough. The register of the coal works at 
Ternes show that, during the past six months, nine 
hundred and one patients have been subjected to this 
vapor treatment, and that of these, two hundred and 
nineteen were cured, and one hundred and twenty-two 
relieved. The favorable results are probably due to the 
ammoniacal gases and the tar vapor associated with it. 



220 THE INHALATION OF MEDICATED 

See more recently on the same subject Schmidt's 
Jahrhiicher, July, 1866, p. 63. 

In this connection it will be interesting to record here 
the results of some experiments performed upon cases 
of whooping-cough, at the St. Annen Children's Hospi- 
tal, of Vienna, with the view of determining the effect 
of the inhalation of various gases in the treatment of 
this affection. 

These results are summed up as follows : 

1st. Inhalation of pure oxygen gas did not, in any 
instance, produce paroxysms of cough. 

2d. Inhalation of nitrous oxide gas, or of a mixture 
of oxygen and atmospheric air in equal parts, did not 
produce a single paroxysm of cough, even when the in- 
halation was continued for a considerable period. The 
children inhaled it with eagerness for from five to ten 
minutes, and would have continued to do so longer, had 
permission been allowed. 

3d. Inhalation of pure nitrogen and hydrogen was 
attempted only on a single occasion ; the children 
breathed it very unwillingly, and only for a very short 
period. In two cases, the inhalation of nitrogen was 
interrupted by paroxysms of cough. Inhalation of 
hydrogen produced disposition to cough in one case. 

4th. The inhalation of carbonic acid gas always pro- 
duced a very heavy fit of coughing at the first deep 
inspiration, even when the experiment was continued 
for a very short time. An experiment was made with 
a mixture of one volume of carbonic acid gas with 
fifteen volumes of ordinary air, which always produced 
a fit of coughing, either immediately or within two or 
three minutes. With further dilution the result was 
not constant, but fits of coughing followed much more 



AIRS, GASES, AND VAPORS. 221 

frequently than from the inhalation of pure atmos- 
pheric air. 

5th. A very slight proportion of ammoniacal vapor, 
so slight that it could not be detected by the sense of 
smell, in the limited number of cases in which it was 
tried, was followed by constant severe paroxysms of 
cough. 

Dr. Hauke, in summing up the practical results of 
these experiments, and arguing from the fact that car- 
bonic acid gas is the gas most obnoxious to whooping- 
cough, on the ground that there is some arrest of the 
separation of carbonic acid gas in the lungs, puts the 
following question : Does this arrest or hindrance to 
the separation of carbonic acid gas from the lungs of 
children laboring under whooping-cough, throw any 
light upon the cause of the peculiar fits of coughing ? 
His anatomical and clinical experience assures him that 
such is the case, and although his investigations have 
not furnished any specific remedy against whooping- 
cough, some valuable assistance has been gained in de- 
cs " O 

creasing the number and severity of the paroxysms of 
cough. 

These investigations appear to substantiate the old 
advice to permit whooping-cough patients, free from 
fever, to be out in the open air as much as possible on 
still, sunny, summer days. In the confined space of a 
sick-room, the air loaded with carbonic acid gas, and 
the volatile ammoniacal particles of the various excre- 
tions, is in itself sufficient to induce cough. Out in the 
open air, on the contrary, where nature furnishes in 
every leaf an apparatus for the generation of oxygen, 
not only is such injurious effect prevented, but the 
greater liberation of carbonic acid gas, by promoting 

19* 



222 THE INHALATION OP MEDICATED 

the respiratory process, will have a calmative effect 
upon the paroxysm. When the state of the weather is 
such as to prevent the egress of the child into the open 
air, it is advisable on the same grounds, to place in the 
chamber many-leaved, blossomless plants, meagre in 
perfume, so as to increase the proportion of oxygen in 
the atmosphere of the apartment, particularly for a few 
hours after a meal, because at this time the production 
of carbonic acid in the organism reaches its maximum. 
For similar reasons such articles of nutrition should be 
selected as are least productive of carbonic acid gas, 
and which by their high oxidation, require but a small 
quantity of oxygen for their combustion in the system. 
Therefore the diet most appropriate under such circum- 
stances, are materials rich in fatty constituents, such 
as milk, sugar, and starches. On the same principles, 
great attention should be paid to the condition of the 
skin, by the use of frequent ablutions, baths, &c. 
(Jahrb. fur Kinderheilkunde, 1862 ; Med. Neuigh. fur 
Aertzter, Erlangen, 1862, ISTo. 22 ; Lewin, p. 202.) 

The inconvenience often attendant upon sending 
children with whooping-cough to the gas-works, a prac- 
tice which he had pursued with good effect in 1864, led 
Dr. Lochner (Gazette Medicale, Oct. 20th, 1866) to 
the attempt to employ at home, in the case of his- own 
son, one of the substances contained in the purifying 
chambers of the gas-works, and he selected benzine, 
with the vapor of which he kept the room impregnated 
by pouring a few drops upon the bed of the patient. In 
the case of his own child, in whom the paroxysms were 
very violent, though only numbering five or six in the 
twenty-four hours, the disease lasted but six days. He 
also employed the benzine internally, ten or fifteen 



223 



drops daily in a little water ; and when the child was 
sleeping, sprinkled a few drops upon the bed. 

Inhalation of Chloroform. 

The inhalation of chloroform has been recommended 
in whooping-cough by Dr. Fleetwood Churchill as 
controlling the disposition to cough, the whoop, &c. (See 
Braitheivaite, 1853, p. 93.) 

Mr. Gr. H. Heath, of Newcastle-on-Tyne, reports 
that in cholera, cases where the vomiting is excessive 
will sometimes be controlled by inhalations of chloro- 
form, when nothing else will do so ; and life may in 
this way be saved. (Lancet, Oct. 15th, 1853.) 

The inhalation of chloroform has been recommended 
in asthma, also in spasmodic croup, in order to over- 
come the spasm. It is also employed for a similar 
purpose in angina pectoris, colic, and other painful 
affections, without pushing the administration to the 
abolition of sensation or consciousness. 

Its uses as an anaesthetic do not come under con- 
sideration in this volume. 

Inhalation of Sulphuric Ether. 

Inhalations of sulphurous ether have been recom- 
mended as almost an abortive in pneumonia. Skoda 
states that he has never seen it exercise any modifying 
influence, even in the earliest stages. 

They have been highly recommended in whooping- 
cough, spasmodic asthma, and in chronic affections of 
the air-passages generally, and it is not unlikely that 
much of the benefit arising from the inhalation of 
ethereal solutions of the balsams is due to the sulphuric 
ether. 



224 THE INHALATION OF MEDICATED 

Inhalations of " naphtha vitrioli" (sulphuric ether), 
were recommended by Joerdans {Copland's Diet.) in 
certain affections of the respiratory organs. 

Ether, impregnated with musk, camphor, assafoetida, 
opium, &c, is sometimes preferable to pure ether. 

Inhalations of sulphuric ether, alone or combined with 
the vapor from preparations of conium, were advised by 
Dr. Richard Pearson in cases of phthisis, as an agent 
in abating the hectic, checking the sweats, relieving the 
dyspnoea, and deodorizing the sputa. He does not rec- 
ommend them as curative, but as affording very grate- 
ful relief to such patients, who will not willingly dis- 
continue their employment, after having once expe- 
rienced their benefits. 

Inhalations of ether, impregnated with squill by the 
addition of the tincture, are recommended in asthma by 
the same authority. (Coxe,On Medical Inhalation, Phil- 
adelphia, 1845.) 

Scudamore employed inhalations of ether in spas- 
modic asthma. 

Dr. Eberle recommended the inhalation of ethereal 
vapors in pulmonary affections. He considered them 
of very great value in relieving dyspnoea. (Coxe, op. cit.) 

In the dyspnoea dependent on chronic bronchitis, 
Prof. Wood considers the inhalation of ether doubly 
useful, if carefully managed, both by relieving the dis- 
tressing sensation, and favoring mucous secretion. 
( Wood's Therapeutics, 2d edit., vol. ii, p. 697.) 

Dr. Physick, of Philadelphia, was in the habit of 
employing the vapor from equal parts of Hoffman's 
anodyne and laudanum, in cases of recent catarrhs, in 
coryza, and obstinate hoarseness; and its value in these 






AIRS, GASES, AND VAPORS. 225 

cases is attested by Dr. Chapman in his work on Ther- 
apeutics. 

Dr. W. Y. GrADBERRY, of Lexington, Kentucky, re- 
cords in the Nashville Journal of Medicine and Surgery, 
October, 1866, some cases of capillary bronchitis treated 
effectually with inhalations of ether. 

The same gentleman has furnished me with the fol- 
lowing notes of the effect of the same treatment in a 
case of acute bronchitis : " Early in the winter of 1866-7, 
the Rev. Mr. B n left Lexington, Miss., for Cincin- 
nati, Ohio, suffering with catarrh, and returned in ten 
days with a violent attack of bronchitis and diarrhoea. 
During the first week his fever was high, with a pulse 
ranging from 110 to 130. He complained of oppression 
of the chest, dyspnoea, and loss of sleep. After a week's 
trial with the remedies usually adopted in such cases, I 
became alarmed for the safety of my patient, and de- 
termined to use inhalations of sulphuric ether. By it 
the dyspnoea was immediately relieved, sleep became 
natural and refreshing, his harassing cough gradually 
subsided, and he soon recovered. He took it at inter- 
vals, pro re nata." Dr. Gadberry informs me that he 
had recently asked this patient his opinion of the effi- 
cacy of the ether in his case, and he assured him that it 
had given decided and permanent relief. 

In a letter to Dr. Gadberry, from Dr. W. H. Wil- 
liams, of Lexington, Kentucky, the latter gentleman 
writes under date of April 15, 1867 : " During the 
spring of 1866, I was the subject of severe bronchial 
catarrh, which persisted for many weeks, resisting the 
ordinary course of treatment prescribed by adapted au- 
thorities, when, at your suggestion, I began the use of 
ethereal inhalations, the disease at this time having as- 



226 THE INHALATION OF MEDICATED 

sumed a gravity well calculated to arouse my suspicion 
of approaching tuberculosis. I first used sulphuric 
ether, and it served well the purpose of relieving the 
frequent paroxysms of dyspnoea, which, though not se- 
vere, were extremely annoying. Subsequently I adopted 
the use of equal parts of ether and tar, and with more 
gratifying results than I had experienced from the use 
of ether alone. 

"The combination seems to promote a free and easy, 
yet not a copious expectoration, but on the contrary ex- 
hibits a decided tendency to overcome the hypersecre- 
tion. This, perhaps, is due to a sedative and antiphlo- 
gistic influence exerted by the tar-vapor upon the in- 
flamed mucous membrane. I pursued this course for 
some weeks, to my entire relief." 

Dr. Samuel W. Francis, of Newport, Rhode Island, 
writes me that he has employed inhalations of ether for 
a bad sore throat, to which he is subject, and feels con- 
fident that the inhalation not only alleviated the symp- 
toms but cured the sore throat ; and he has formed the 
opinion that we have a valuable remedy by this means, 
in the treatment of bronchitis. 

The inhalation of sulphuric ether has been recom- 
mended from various sources as a valuable remedy in 
cases of hysterical or nervous aphonia. I have myself 
on several occasions, been able to restore the voice in 
cases of aphonia in this way, but all of my cases occurred 
in* military practice during the late civil war, and I 
have no reason to believe that they were not those of 
malingering in every instance. It was curious to notice 
in some of the cases, after the subjects had learned the 
object of placing them under an anaesthetic influence, 
how well they could control themselves while going under 



AIRS, GASES, AND VAPORS. 227 

the influence of the ether, not a sound escaping them 
until the moment of unconsciousness; but, oblivion hav- 
ing once ensued, the effect in coming-to was not antici- 
pated, or if anticipated, was forgotten under the an- 
aesthetic state, and the intoxication would be evinced by 
the usual clamors, when a sudden restoration of con- 
sciousness would announce to them, with a moral shock, 
the cure of their aphonia. 

I have, however, succeeded in restoring the voice in 
cases of so-called nervous aphonia, by the injection of 
sulphuric ether into the larynx, but here the result was 
due to the local stimulus, rather than to the thera- 
peutic effect of the ether. 

Dr. F. D. Lente, of Cold Springs, New York, re- 
cords (Am. Med. Times, April 6, 1861, p. 224) a case 
of hysterical aphonia cured by the inhalation of sul- 
phuric ether. This was an unmarried female, set. 40, 
who had been an invalid for several years. Early in 
1860 she lost her voice so that she could not articulate 
above a whisper. In December of that year she was 
placed under the influence of sulphuric ether for the re- 
duction of a strangulated femoral hernia, and twice, on 
recovering from the anaesthetic influence, the patient ex- 
pressed her belief that she articulated with less effort, 
although she still spoke in whispers. Brought a third 
time under the influence of the ether, preparatory to 
the operation, certain attendant circumstances kept 
her under the influence of the ether for two hours, and 
as soon as she had fully recovered from its effect she 
exclaimed aloud — " Doctor, I can speak !" and her 
voice remained permanent up to the date of the report. 

Dr. Lente instances a case reported a short time pre- 
viously, in which a carman of London recovered the use 



228 THE INHALATION OF MEDICATED 

of his voice after a deprivation of eight months, while 
under the influence of chloroform, for the purpose of 
overcoming some rigidity about the muscles of his jaw. 

Dr. L. Nordmann, of this city, writes me under date 
of April 6th, 1867, that at Haddington U. S. A. Gen- 
eral Hospital, he had under his charge, in 1864, three 
cases of complete aphonia in United States soldiers, 
young men otherwise healthy. These men were not 
considered malingerers by himself nor by his colleagues. 
They each had made a similar statement, that loss of 
voice followed a severe cough contracted during pro- 
longed exposure to wet and cold while on duty, some 
three months previous to his seeing them. Having 
heard of a case of aphonia successfully treated in Balti- 
more by inhalations of sulphuric ether, Dr. Nordmann 
determined tQ try the eifect of the inhalation of ether 
on these cases, and as the effects of the anaesthetic 
passed off, each, to his great surprise, had recovered 
the proper use of his voice. 

Dr. James H. Hutchinson, of this city, reports 
(Am. Jour. Med. Sci., April, 1864, p. 412), a case of 
loss (hysterical) of speech and hearing successfully 
treated by the inhalation of ether. C. C, a German 
girl, aet. 20, was admitted to the Episcopal Hospital, 
September 22d, on account of entire loss of speech, 
which had occurred ten days previously. Complete 
deafness supervened two weeks after her admission. 

The history of the case is as follows : She had always 
enjoyed good health up to two and a half years previous, 
when she was about to leave Germany for this country. 
At that time she had a violent quarrel with her fellow- 
travellers, which gave rise to a hemorrhage from the 
lungs. During the voyage she had several convulsions, 



AIRS, GASES, AND VAPORS. 229 

but upon her arrival in this country she was sufficiently 
woll to take the place of cook in a private family, and 
she continued in good health, with short interruptions, 
up to September of 1863. Dr. Hutchinson found her 
in the wards of the hospital when he took charge of 
them at the beginning of the year. He learned that 
she had had but few convulsions while in the hospital, 
and that the usual remedies had been tried without re- 
lieving her condition. Electricity, the various tonics, 
nux vomica, and lastly, sulphate of aniline, had all 
been resorted to without benefit. During all this time, 
her only means of communication with others was by 
means of a slate. Dr. H. was anxious to discover 
whether the loss of speech and of hearing was in any 
degree feigned, and with that view the resident physi- 
cian was directed to administer ether to her by inhala- 
tion, in the belief that if such were the case, she would 
find words as she came under the influence of the an- 
aesthetic. The result, however, was different from what 
had been expected. The ether threw her into a slight 
convulsion, from which she soon recovered, having en- 
tirely regained her hearing. The experiment was 
directed to be repeated twice subsequently. Upon re- 
covering her consciousness she was able to say ma?nma, 
and to make various inarticulate sounds. She was a 
third time (three days later) placed under the influence 
of ether, with the following curious result, — that of re- 
covery of speech and loss of hearing. A fourth ether- 
iz-ation produced no immediate result ; but in the course 
of a few days after, she was able first to hear loud noises, 
and later, to understand what was said when spoken in a 
loud tone of voice. The improvement after this was 
very rapid, and by the middle of January her recovery 

20 



230 THE INHALATION OF MEDICATED 

was complete. She was retained in the hospital for 
observation until the beginning of February ; but as 
she continued quite well, she was discharged at this 
time at her own request. Her joy at her recovery may 
well be imagined, as all hope had been abandoned by 
herself and friends, by whom application had been 
made to the managers of the Deaf and Dumb Asylum, 
for her admission to that institution. 

The Montreal G-azette Medicate publishes from LA- 
beille Medicate, the report of two cases of diphtheritic 
angina, or false membranous croup, treated with suc- 
cess by inhalations of ether, under charge of Dr. M. 
Besson. 

The first patient was a girl six years of age, who 
presented the. following symptoms : Swelling of the sub- 
maxillary glands, puffed face, pulse slightly accelerated, 
pain in the throat, difficulty in swallowing, mucous mem- 
brane of fauces engorged and reddened, tonsils strongly 
tumefied, and presenting several patches of the pellicu- 
lar exudation which characterizes diphtheritic angina. 
Voice gone; cough dry, choking, and croupy. Respi- 
ration short, accelerated, and labored. The patient was 
at first treated in the usual manner, — by vomits of tar- 
tar-emetic and ipecacuanha, &c, chlorate of potassa, 
mercurial frictions around the neck, — ^with no effect, how- 
ever, except the expulsion of some membranous shreds 
and patches. As a dernier ressort, Dr. B. thinking it 
unadvisable to resort to tracheotomy, inhalations of 
ether were employed. The effect was an attack of suf- 
focation, accompanied by a violent respiratory struggle, 
lasting nearly a minute, during which a false membrane, 
over six centimetre's in length, and three millimetres in 
thickness, very dense, like a piece of parchment, was 



AIRS, GASES, AND VAPORS. 231 

expelled. The effects of this paroxysm gradually sub- 
sided, and the patient soon went into a calm sleep. 
After about eight hours the symptoms recurred, and 
again recourse was had to the ether fumigations, result- 
ing in further expulsion of false membranous exudation. 
Calm and sleep again supervened, the croupy symptoms 
yielded, and in a few days complete recovery had taken 
place. 

The second patient was a little boy, five years of age, 
who was attacked with diphtheritic angina. Vomits of 
sulphate of copper, &c, had been used, followed by the 
expulsion of some false membrane, but still the symp- 
toms became aggravated. There was complete aphonia, 
tonsils tumefied, and covered with whitish patches ; cough 
insonorous and choking ; successive dyspnoea ; convul- 
sive movements of the expiratory muscles ; quick, sibi- 
lant inspiration ; face congested ; eyes injected ; jugu- 
lars distended ; extreme anxiety, convulsive agitation, 
and intense fever. In short, the patient was in the 
midst of these terrible paroxysms, which have hardly 
any remission, and which announce that the final symp- 
toms of asphyxia are near at hand. In this condition 
the patient was made to inhale, in the space of several 
minutes, about five drachms of vaporized ether, and 
soon afterwards, in the midst of the violent efforts of 
a veritable strangulation, he expelled, enveloped in 
thready mucosities, a false membrane, seven to eight 
centimetres long, two centimetres in its greatest circum- 
ference, and very dense. In half an hour the symp- 
toms of amelioration had become so decided, that the 
disease was thought to be broken, and during the fore- 
part of the night the little patient rested quietly. 



232 THE INHALATION OF MEDICATED 

Towards midnight, the dyspnoea and the paroxysms 
became again urgent and violent, so that the patient 
himself cried for the use of the ether. This second 
fumigation produced the expulsion of several pieces of 
false membrane, rolled upon themselves, but smaller 
than the previous one. Again, subsidence of the croupy 
symptoms, and their occasional re-occurrence during the 
next two days, when the ether was again applied. 

The patient finally recovered. 

The evaporation of the ether in these cases was ac- 
complished by very simple means, placing a bottle con- 
taining the ether, and terminating in an extemporized 
tube, into a bowl of water of 40° Cent., the ether fumes 
were thus carried from the tube with the air of inspira- 
tion into the air-passages. [Med. and Surg. Reporter, 
Philada,, April 25th, 1866.) 

Dr. E. R. Livingston, of Plattsmouth, Nebraska, 
communicates to the Am. Jour. Med. Sci., April, 1867, 
p. 376, the particulars of a case of laryngitis with ex- 
udation of lymph, treated with inhalations of sulphuric 
ether. On the 4th of January, Dr. L. was called to a 
little girl set. two, the messenger informing him that 
the patient had croup, and was dying. Previous to his 
arrival, the mother had administered a full dose of 
syrup of squills, and he found the patient vomiting and 
purging freely. Pulse 150 ; tongue slightly coated, 
somewhat swollen, and red ; fauces red, with an engorged 
appearance ; tonsils slightly swollen ; considerable ten- 
derness over the larynx; eyes watery; breathing slightly 
stridulous, the mother stating that previous to emesis it 
was very labored, or, as she expressed it, " the child was 
choking;" countenance expressive of great anxiety ; and 



233 



though no coughing occurred at the time of the doctor's 
visit, he was informed that she had coughed repeatedly 
with a ringing, croupy cough. 

Inhalations of lime-water were directed, as hot as 
could be borne by the child ; also one of the following 
powders every two hours, viz. : 1^. hyd. chlor. mit., gr. 
x. ; antim. et pot. tart., gr. j. ; ammoniae hydrochlor., 
5j ; M. ft. chart. No. xii. The mother of the child was 
instructed to keep a large open kettle of water boiling 
on the stove, for the purpose of moistening the atmos- 
phere. 

About midnight Dr. L. received a most urgent request 
to visit the child immediately, as she was suffocating. 
Before entering the chamber of the invalid, he was 
struck with the loud wheezing noise of her respiration, 
and the peculiar loud, ringing cough. There was 
great dyspnoea ; respiration performed with difficulty ; 
nostrils dilated ; muscles of chest and neck violently 
exerted ; lips livid, and head thrown backwards, with 
great restlessness, and a slightly cyanosed appearance 
of the countenance. On inquiry, he was informed that 
the lime-water inhalations had afforded temporary relief, 
but that each time they were left off the difficulty of 
breathing recurred in a short time. 

The parents were informed of the perilous condition 
of their child, for whose recovery tracheotomy appeared 
to offer the only hope, though with very little encour- 
agement. At this moment, remembering the suggestion 
of Dr. Black and Dr. Gadberry, he proceeded to ad- 
minister some of Squibb's ether by inhalation, according 
to the directions of Dr. Lente, as reported by Dr. 
Packard in the Am. Jour. Med. Sci., for Jan. 1866, 
premising the inhalation by the internal administration 

20* 



234 THE INHALATION OF MEDICATED 

of half a teaspoonful, which, as anticipated, was swal- 
lowed with difficulty, and caused a severe paroxysm of 
coughing. 

In precisely eight minutes from the time the patient 
commenced the inhalation, the abnormal muscular exer- 
tion ceased ; a general relaxation took place ; the pulse 
fell to 100, and the peculiar "flip" sound of partially 
detached membrane was distinctly heard during expira- 
tion ; the loud wheezing noise of the breathing abated, 
and in thirteen minutes the child was sleeping in com- 
parative ease. In about ten minutes more she coughed, 
not with the loud, ringing, metallic sound so peculiar 
to this affection, but with the moist rale which every 
practitioner hails as the harbinger of success in the 
treatment of this dreadful malady. The coughing was 
followed by efforts at vomiting, and numerous portions 
of membrane were discharged, the edges having a whit- 
ish, and the centres a grayish appearance; they were 
oblong in shape, from an eighth to three-fourths of an 
inch in length, and from half a line to a line in thick- 
ness. A few times more, at short intervals, coughing 
occurred, followed by emesis and the expulsion of ad- 
ditional portions of membrane. The vomiting now 
ceased, and the child slept almost naturally, the respira- 
tion being normal. Her sleep was frequently disturbed 
by short fits of coughing ; but the intervals of rest in- 
creased in duration, and no more membrane was expelled, 
though it was evident that she occasionally swallowed 
portions without completely awakening. At 4 o'clock 
the child was *out of danger ; at 10 A. M. awake and 
playful. The recovery was entire. 

In commenting on this case Dr. Livingston acknowl- 
edges that the previous exhibition of the powders, and 



235 



the inhalations of the nebulized lime-water, may render 
it doubtful if the recovery was entirely due to the inha- 
lation of the ether ; and suggesting that the spray of the 
lime-water is in great measure carbonated by inhala- 
tion, and thus rendered inoperative, he attributes the 
temporary relief afforded by its administration to the 
warm moisture of the water. But as there was no evi- 
dence of permanent relief until the administration of 
ether by inhalation, and the favorable effect of the latter 
was rapidly produced under his direct observation, he 
has no hesitancy whatever in ascribing the recovery to 
the ether. 

Dr. W. Y. Gadberry, of Yazoo City, Mississippi, 
has furnished me the following notes of a case of croup 
treated by inhalations of sulphuric ether : 

" On the night of the 15th of April, 1867, I was 
called, in the absence of the attending physician, to see 
a child of Mr. M , get. eight months. When I ar- 
rived the child was in imminent danger of dying from 
non-plastic croup. It had been relieved on the night 
previous with emetics of alum and lobelia, and cold ap- 
plications to the throat. The fever, however, continued 
up to the time of my visit. I ordered an alum emetic, 
which acted promptly ; applied turpentine and hot 
flannels to the throat, and a snuff plaster to the chest. 
In the course of half an hour the symptoms improved 
some little, but not enough to justify my departure, or 
any assurance of permanent relief. I then resorted to 
inhalations of sulphuric ether, which gave complete 
relief in five minutes to all the difficulty of respiration; 
nor did it return any more. To relieve the febrile ex- 
citement I directed hyd. cum creta, to be repeated 
until it acted on the bowels." 



236 THE INHALATION OF MEDICATED 

The anaesthetic virtues of ether do not come under 
consideration in this volume. 

Inhalation of Balsamic Vapors. 

The custom of sending patients with pulmonary com- 
plaints to localities where they might constantly breathe 
the balsamic atmosphere produced by the vegetation of 
aromatic plants, is of very ancient origin. 

In the middle of the seventeenth century, Dr. Bennet 
of London employed an artificial atmosphere of this 
kind, by the fumigations of frankincense, styrax, and 
turpentine, with coltsfoot, cinnamon, &c, in powder, 
or made into troches and burned upon coals. He also 
employed the vapors from mixtures of herbs over which 
boiling water had been poured. [Copland's Diet.) 

They were much used by Mead and others, and are 
recommended among other inhalations by Dr. Tweedie, 
in his treatise on Diseases of the Respiratory Organs, 
as promotive of secretion. 

Balsamic inhalations at one time attracted a great 
deal of attention in continental Europe ; they were rec- 
ommended by Delpit, Rullier, Maygrier, and others, 
and very strongly by Trousseau and Pidoux in the 
treatment of chronic pulmonary catarrhs, and obstinate 
cases of chronic laryngitis, especially when connected 
with ulceration. 

The plan advised by Trousseau and Pidoux is to 
throw some of the balsam upon live coals, which they 
consider preferable to the method of pouring boiling 
water upon some of the material in an inhaler, because 
after their method, the apartment becomes filled with 
the vapor, and the patient can remain for whole days 
in an atmosphere thus impregnated. They state that 



237 



chronic catarrhs have been cured in this manner after 
failure with the same remedies used internally. 

These inhalations were found valuable in phthisis, as a 
means of preserving strength, and thus prolonging life. 
The balsams most constantly employed were benzoin, 
and, more frequently, balsam of Tolu ; and the balsam 
of Peru was also occasionally employed in the same 
way. 

Inhalation of an ethereal solution of Tolu has been 
successfully employed by M. Roziere in cases of bron- 
chial catarrh, loss of voice, and chronic affections of the 
chest generally. His plan is to mix 20 grammes of the 
balsam with 60 grammes of sulphuric ether ; the mix- 
ture to be placed in a wide-mouthed bottle which the 
patient holds, uncorked, to his nose for two or three 
miuutes every half hour. 

As, however, the inhalation of sulphuric ether alone, 
as mentioned previously, is very highly recommended 
in these very affections, it is not improbable that much 
of the beneficial effect of the ethereal solution of Tolu 
is attributable to the menstruum. 

To employ the balsams with the ordinary inhaler, 
boiling water may be poured upon one or two drachms 
of the drug. 

The balsam of copaiba has been much used in inha- 
lation by Dr. Edward J. Coxe, of Baltimore, in the 
treatment of chronic laryngeal and bronchial affections. 

Inhalations of Vapors of Turpentine. 

Professor Skoda has treated gangrene of the lung 
successfully by turpentine inhalations. His plan is as 
follows : The essence of turpentine is poured upon boil- 
ing water and the patient is directed to inhale the vapor 



238 THE INHALATION OF MEDICATED 

arising therefrom for fifteen minutes every two hours. 
Sulphate of quinia is also administered in the usual 
doses. Four cases are reported (Medical Times and 
Grazette, April 15, 1853 ; and Zeitschr. filr K. K., 
G-eselsch. der Aerzte zu Wien., 1853, t. ix, p. 445). 
The first case was that of a servant affected with limited 
gangrene of the superior lobe of the right lung. After 
six weeks of this treatment, it became impossible to de- 
tect either infiltration or gangrene of the organ. On 
the contrary, the respiratory murmur had returned over 
the whole region. Three months afterwards the patient 
was seen in good health. 

In the second case, an innkeeper, of mature age and 
strong constitution, became the subject of a gangrenous 
cavity in the lower lobe of the right lung, consequent 
upon disease commencing March 11, 1852. On March 
21st, the patient began with the inhalations of the 
vapor of turpentine ; he continued, without repugnance, 
for five or ten minutes every two hours, taking, at the 
same time, the usual doses of quinia. At the end of 
three weeks, the expectoration, which had been extremely 
abundant (a pint and a half daily), became reduced to 
a quarter of a pint. The inspirations had been em- 
ployed four times a day. At the end of six weeks the 
patient could quit his bed. His strength was returning, 
the appetite was improving, and his general aspect 
favorable ; but the expectoration continued to be fetid 
from time to time, and was always sanious. The right 
side of the chest was painful, and respiration labored, 
but the air entered the circumference of the lower lobe ; 
the respiration being uncertain and accompanied by 
feeble rales and sibilance. The patient went into the 
country, where he continued the turpentine inspirations 



AIRS, GASES, AND VAPORS. 239 

twice a day up to the middle of July, when both cough 
and expectoration had entirely disappeared. In the 
month of December, 1852, he came to M. Skoda for a 
certificate of health. There was no pain, nor oppres- 
sion, nor cough. He had recovered his embonpoint and 
his strength ; there was no retraction of the thorax ; 
vesicular respiration everywhere. 

In the third case it was not in the Professor's power 
to persist in the plan. 

The fourth case was still under treatment. A butcher, 
of strong constitution, had a gangrenous cavity in the 
inferior lobe of the left lung. He fell ill about the end 
of May, 1852. The inspirations of turpentine were 
commenced June 4th. At the end of a week, the fetid 
expectoration, which daily equalled two pints, had en- 
tirely disappeared, and the patient considered himself 
well, because the pain and the oppression in breath- 
ing had diminished, the appetite had returned, and the 
sleep was tranquil. He therefore left off inhaling the 
turpentine, which was extremely disagreeable to him. 
On June 19th there came on a severe shivering fit, with 
cough and dyspnoea, and during the following night the 
patient expectorated several pints of extremely fetid 
sanies of dirty brown color. The inspirations were rec- 
ommended, but the patient used them as little as possi- 
ble, on account of the irritation which they produced in 
the air-passages. In eight days the quantity of matter 
brought up had greatly diminished, and the pulse was 
normal, but there was pain in the chest. The patient 
lay immovable upon his back in a state of great weak- 
ness and prostration; there was no appetite. The lower 
lobe of the left lung was impervious to air. The inspira- 



240 THE INHALATION OF MEDICATED 

tions were again suspended, but again recommenced on 
account of recurrence of the bad symptoms, the disa- 
greeable odor of the turpentine being partly rectified by 
a few drops of the essence of rose. About the middle 
of October he was able to go into the country, having 
recovered strength sufficient to leave his bed ; neverthe- 
less, there remained a sense of oppression and pain 
under the left scapula. At the end of January he con- 
sidered himself well. There was a sudden expectora- 
tion of two ounces of blood, after a slight fit of cough- 
ing, on February 10th, probably proceeding from the 
callous walls of a former gangrenous cavity ; but there 
are no signs of further infiltration, and the case seems 
likely to terminate well {Banking's Abstract, 1854, 
vol. 19, p. 69). 

The inhalation of the vapors of turpentine has also 
been recommended as a remedy in whooping-cough 
(Schmidt's Jahrbilcher, 1866 ; Band 130, p. 63). 

The oil of turpentine may be inhaled by putting 20- 
60 drops in an ounce of water and applying heat. 

Inhalation of the Vapors of Tar. 

Sir Alexander Crichton published, in 1817, " An 
account of some experiments made with the vapor of 
boiling tar in the cure of pulmonary consumption," in 
which he explains that accident led him to the discovery 
of this potent remedy, which he placed before the notice 
of the profession. 

Drs. Bluhm and Von Roos, reporting upon the value 
of these inhalations, state, as the result of the study of 
many cases, that the tar fumigations produce a very 
prompt and salutary effect upon the cough, the expec- 



AIRS, GASES, AND VAPORS. 241 

toration, and the respiration ; and that the sleep be- 
comes more tranquil, continuous, and restorative ; and 
that the patient thus regains strength. (Ctfxe, op. cit.) 

The tar recommended by Sir Alexander Crichton is 
that used for the cordage of ships, to every pound of 
which he added half an ounce of the subcarbonate of 
potassa, in order to neutralize the pyroligneous acid. 

He placed the vessel containing the tar over a spirit- 
lamp, taking care that it should boil slowly and not 
burn ; the tar being renewed every three hours, so as to 
keep the apartment impregnated with the vapor night 
and day. The vessel must be cleansed daily to prevent 
the incineration and decomposition of the residuum, 
which is irritating. 

These fumigations were not employed alone, other 
remedies being employed as deemed advisable. 

Dr. Mackintosh {Practice of Physic) recommends 
the inhalation of the vapors of tar in chronic uncom- 
plicated bronchitis. 

Dr. Eberle recommends the fumes of tar in whoop- 
ing-cough. 

Dr. M. Baillie, of London, attests the value of inhala- 
tions of vapors of boiling tar and vinegar, in tonsillitis, 
and similar affections. 

Dr. Morton, of Philadelphia, employed inhalation of 
tar vapor extensively as a palliative in consumption, 
and preferred it to any other method of treating chronic 
catarrh. 

Prof. Wood (Therapeutics, &c, 2d ed., vol. i, p. 78) 
has witnessed the happiest effects from the vapors of tar, 
when continued for months, in very threatening chronic 
pulmonary disease. 

I have frequently seen benefit from the vapors of tar 
21 



242 THE INHALATION OF MEDICATED 

in cases of advanced phthisis, and in chronic bronchitis, 
where, if it has no other local influence, it at least re- 
duces the irritability of the mucous membrane, checks 
hypersecretion to some extent, and facilitates expecto- 
ration, thus conserving the powers of the patient. In 
recent inflammations, and in the hectic fever of phthisis, 
its use requires caution, as it has been said to induce 
congestion, and may thus give rise to hemorrhage or 
severe inflammation. 

Prof. Chapman found benefit from the fumes of con- 
centrated pyroligneous acid in foul ulcerations of the 
throat and nostrils [Therapeutics, vol. ii, p. 36). 

Inhalation of Vapors of Creasote. 

Creasote may be inhaled in the proportion of three 
to fifteen drops to the ounce of water, heat being 
applied; or it may be employed alone at ordinary tem- 
peratures. It may be inhaled from any of the inhalers ; 
or very simply, by pouring boiling water over a few 
drops of creasote in the bottom of a teapot, and inhal- 
ing through the spout. 

Creasote inhalations will, it is said, often relieve the 
irritating cough of phthisis, after the failure of opiates 
and like remedies, allaying the irritation, checking the 
secretion, assisting expectoration, and thus acting ben- 
eficially by conserving the patient's strength, prevent- 
ing exhaustion from paroxysms of severe cough, &c, 
even if it has no specific remedial agency. 

Inhalations of vapors of creasote are reported to 
agree usually very well from the first ; but in irritable 
constitutions, where they are not so readily tolerated, 
it has been recommended to subdue the irritability of 
the mucous membrane, by a previously instituted inha- 



AIRS, GASES, AND VAPORS. 243 

lation of the vapor from coniutn ; and where there is 
any tendency to spasm, to add a few drops of the liquor 
potassse at the moment of employing the inhalation. 

Dr. Elliotson [Med. Chir. Trans., vol. xix, p. 217) 
records that in phthisis, he has, in many instances, 
caused patients to breathe for four or five minutes at a 
time, and four or five times a day, a mixture of creasote 
with mucilage and water, but without any decided result. 
He has found such inhalations useful, however, in cases 
of bronchitis with profuse discharge, those designated 
as bronchorrhoea ; he has also found them useful in 
asthma; and so also in chronic affections of the larynx, 
trachea, and bronchi generally, he has found them of 
great advantage, both when used alone, and when con- 
joined with other medications ; and he has not known 
any inconvenience to have resulted from their employ- 
ment in a single instance. 

MM. Serres and Andral, in their report read at 
the seance of the Academie des Sciences, Nov. 30th, 
1857 {Gazette Hebdomadaire, Dec. 11th, 1857), upon 
fumigations of acetic acid and creasote in the treatment 
of chronic bronchitis, recommended by M. L. Mandl, 
state that the varieties of bronchitis for which this treat- 
ment is recommended are, the dry catarrh of Laennec ; 
chronic bronchitis with unilateral subcrepitant rale ; 
and the bronchitis of pleurisy. These three varieties 
form a group which is designated by Mandl under the 
name of bronchite seche, characterized by the paucity of 
symptoms furnished by auscultation and percussion. 
The treatment consisted simply in the employment of 
warm fumigations by means of an apparatus composed 
of a glass globe with double tubulure, furnished with a 
rubber tubing, and placed upon a copper stand. Into 



244 THE INHALATION OF MEDICATED 

the vessel is introduced 60 grammes of water, and 5 
grammes of a solution composed of 5 grammes of crea- 
sote, 50 grammes of acetic acid, and 500 grammes of 
water. The liquid is then heated, and the fumes that 
arise are inspired by the patient. The strength of the 
mixture is to be gradually increased, according to the 
duration of the malady, the susceptibility of the larynx, 
and bronchi, &c. Chronic mucous catarrh will not 
yield to the acid fumigations as readily as the dry 
bronchitis. In such cases he employs the emetics in 
addition, repeated whenever indicated by the abun- 
dance of rales. In the pituitous catarrh, properly so 
called, so frequently connected with an affection of the 
heart, and which in all cases, especially when it has 
existed several years, denotes a considerable degree of 
alteration of the mucous membrane of the bronchi, the 
acidulated fumigations, if well supported, will amelio- 
rate the condition of these tubes, but will not cure them. 

Inhalation of Vapors of Oleum Pini Pumelion. 

Lewin (op. cit, p. 207) speaks of the use of the ol. 
pini pumelion, with a few drops of which he saturates 
a small piece of cotton, which is then placed in the bowl 
of a small smoking-pipe, through which the patient in- 
spires for several hours at a time. This oil, he states, 
contains less resin than the ol. terebinth., and is not 
unpleasant to the taste. The breath and urine soon 
acquire its peculiar odor, proving its absorption. It 
seems partly to induce contractility of the sluggish and 
relaxed vessels, and partly to act as an excitant and 
expectorant to the mucous membranes. More than 
from three to five drops are not to be given in a single 
day, because a larger quantity may become too stimu- 



AIRS, GASES, AND VAPORS. 245 

lating. Dr. Lewin has employed such inhalations with 
success in chronic pulmonary catarrhs, and in pulmonic 
blennorrhea ; and Dr. Boer recommends its loosening 
effect from the relief experienced by himself in a tight 
catarrh. It was at a much earlier date employed by 
Copland in bronchitis, and recommended by him. 

Inhalation of Vapors of Oleum Pini Sylvestris. 

Quite recently (Lewin, op. cit., p. 208), Prof. Ger- 
HARDT, of Jena, has made some investigations into the 
action of the ol. pini sylvest., in chronic affections of 
the respiratory organs. Into a basinful of hot water 
he drops from six drops to two teaspoonfuls of the oil, 
and the patient breathes, through a tube, the vapor that 
is given off, from half an hour to two hours daily. The 
effect of this inhalation is found to be very similar to 
that produced by the oil of turpentine, only that the 
latter is rather more antiseptic, and the former more 
astringent 'and sorbefacient. The best results were ob- 
tained in chronic catarrh of the larynx or bronchi, and 
also in dilatation of the minuter bronchi, one case of 
which was so far relieved after four weeks' inhalation, 
that the lessening of the calibre of the bronchi was 
noticeable, and the expectoration, which previously had 
been profuse, decreased in quantity, and eventually 
ceased ; while an inhalation of sal-ammoniac instituted 
earlier had been followed by hardly any result. 

The inhalations of the oleum pini were not always 
well borne, but in the majority of cases, soon produced 
a decreasing effect upon the amount of expectoration. 

21* 



246 THE INHALATION OF MEDICATED 

Inhalation of the Resinous Vapors of the Conifers. 

Dr. W. W. Ireland [Edinburgh Medical Journal, 
Feb. 1864 ; British and Foreign Med. Chir. Review, 
July, 1864, p. 250) had already made the observation 
that in pine forests, the quantity of ozone in the air 
was increased by their resinous emanations, which con- 
tained, if not ozone itself, at least a substance possess- 
ing many of its properties. He records some practical 
observations made at a little town called Die, in the 
south of France, on the therapeutic effect of resinous 
vapors. This kind of treatment was in popular use 
among the mountains of Dauphind for more than a 
century, and was discovered by accident. Some la- 
borers were cutting wood for preparing pitch, when one 
of them was suddenly seized with acute rheumatism in 
the legs, which disabled him from the more active work, 
but allowed him to arrange the cut wood in the furnace. 
After working a little time at this employment, which 
exposed him to the resinous vapors from the wood, he 
felt his complaint gradually disappearing; and the 
cure thus effected became known among the peasantry, 
and subsequently attracted more particular attention. 

Dr. Chevandier, finding that the peasants suffering 
from rheumatism exposed themselves to the vapors of a 
pitch furnace, and thus became cured of their complaints, 
examined the subject in a scientific manner. He found 
that the peasants had been in the habit of sitting in the 
furnace at a heat of nearly 190° Fahrenheit, and his 
own experience showed that in an atmosphere saturated 
with turpentine vapors, that very high temperature was 
not only tolerable but pleasant, and he himself entered 
the furnace to study its physiological effects. He 



AIRS, GASES, AND VAPORS. 247 

found that the skin perspired freely, the pulse rose, 
and his sensations were agreeable. 

Since these experiments were made, some baths have 
been used at Die, on the same principle as the pitch 
furnace. They resemble a large baking-oven, the fire 
being below ; and the resinous layers of pine wood are 
strewed upon the floor, and the patient sits upon a 
bench, wrapped in a porous covering of wool. 

The temperature to which the patients are exposed is 
generally from 140° to 158° Fahr., and they remain 
from fifteen to twenty minutes. The sensations of the 
patients are agreeable, and the perspiration is abundant, 
the pulse rising from twelve to fifteen beats, and at first 
the respiration is accelerated. After the proper period 
has expired, the patient goes to bed, where he remains 
an hour or two. 

The diseases treated by this plan are rheumatism in 
all its forms ; inflammation of mucous surfaces, as 
chronic bronchitis and laryngitis ; neuralgia ; glandular 
enlargements ; and constitutional syphilis. Nine-tenths 
of the patients who come to Die suffer from rheumatism, 
the muscular form yielding more readily than any other, 
but articular rheumatism yields more slowly. After 
rheumatism, chronic bronchitis appears to be most ben- 
efited by this treatment, probably from the effects of 
the vapor on the diseased mucous membrane. Five 
cases of phthisis are also said to have been successfully 
treated by courses of twenty baths, but most of the 
cases were in the first stage. 

Pectoral complaints never occur among those who 
work in turpentine, and in the south of France it is 
known that these maladies and rheumatism are compar- 
atively rare among the inhabitants of districts covered 






248 THE INHALATION OF MEDICATED 

by pine forests ; and hence it would appear that the res- 
inous vapors possess some important therapeutic prop- 
erties in these diseases. 

Dr. Ireland suggests that the beneficial effects may 
be due to the influence of ozone or antozone upon the 
blood. Hence, fumigations of the resinous layers of 
fresh pine wood, or of oil of turpentine, may be benefi- 
cial in phthisis, or the patient may live in a room or 
conservatory filled with saplings of pine. 

Baths, like those used at Die, have been attempted 
in other places, as at Grenoble, Valence, and near Vau- 
cluse, but the wood the inhabitants employ is said not 
to be the same; and Dr. Ireland recommends patients 
laboring under obstinate rheumatism or bronchitis to go 
to Die, which is reached by a diligence, starting from 
the railway station at Valence. Die is a small town, 
situated in a beautiful valley among the Alps of Dau- 
phin 4, the lofty peaks of which guard it from the mis- 
tral, and its elevated situation saves it from the scorch- 
ing heat of the summer of the South. 

Inhalations of the vapors of resin have been employed 
under the same circumstances as the vapors of tar, tur- 
pentine, creasote, &c, and the well-known effect of 
such inhalations has prompted the practice, which is 
of very ancient origin, of sending patients affected with 
phthisis and other chronic pulmonary affections, for 
temporary or permanent residence, to regions in which 
pine forests abound. 

Also the fumes from burning undressed wool have 
been recommended in cases of chronic laryngitis and 
bronchitis, and they have also been said to prove ad- 
vantageous in phthisis. 

It may be remarked in connection, that the assertion 



AIRS, GASES, AND VAPORS. 249 

has been made that young persons employed in wool- 
factories are exempt from phthisis, in consequence of 
the constant exposure to the inhalation of oil, which is 
used in large quantities in such factories. 

Inhalation of Permanganate of Potassa with Vapor of 
Water. 
Staff- Surgeon Dr. Thalwitzer, of the Prussian army, 
during the recent war with Denmark, employed inhala- 
tions of permanganate of potassa with vapor of water 
in two cases of severe dyspnoea, consequent on gun- 
shot wound of the chest. Five grains of the permangan- 
ate of potash were added to the water inhaled at each sit- 
ting. The instrument employed consisted of a tightly- 
closed cylinder with a funnel-shaped cover, the tube of 
which, after rising for a foot, was bent at an angle and 
then continued horizontally for another foot in length. 
In both cases the expectoration became decreased, and 
in one case, in which pulmonary gangrene had ensued, 
the foul odor was markedly reduced. Both patients 
liked the inhalation, which relieved the difficulty of 
expectoration and improved their general condition. 
{Schmidt's Jahrbucher, 1866 ; Band, 130, p. 140.) 

Inhalation of the Vapors of Nitrate of Potassa. 

Inhalation of the fumes from burning nitrate of potash 
have been much lauded in cases of asthma. Pieces of 
bibulous paper are soaked in a saturated solution of the 
nitrate and then dried. When used, the paper is set on 
fire in a convenient vessel and the patient inhales the 
fumes as they are given off, or merely breathes the air 
of the apartment. Sometimes they are smoked in a pipe 
in the same way as ordinary tobacco. They have also 



250 THE INHALATION OF MEDICATED 

been employed in whooping-cough and in the spasmodic 
coughs attendant upon other affections. Recently they 
have been much recommended by Dr. Hyde Salter, in 
the treatment of asthma. 

Sal Ammoniac — Muriate of Ammonia. 

This substance has been recognized as a beneficial 
agent in the treatment of affections of the throat and 
respiratory organs, from the very earliest periods in the 
records of medicine. 

It was first employed by inhalation, according to 
Lewin, by a pupil of the famous Prof. Schonlein, Prof. 
Fuchs, of Gottingen. In the published report of the 
Gottingen Clinics for 1838 and 1839, it is recorded that 
Prof. Fuchs employed the inhalation of the vapors from 
sal ammoniac in the treatment of chronic catarrhs of the 
respiratory organs, placing the material upon a heated 
porcelain plate, and directing the patient to breathe the 
fumes. Lasseque, more recently, resorted to the same 
means, in France, with satisfactory results. Later, in 
1855, the fumes from sal ammoniac were highly recom- 
mended by Dr. Gieseler in chronic pulmonary catarrh, 
and his method of administration is as follows : Two or 
three teaspoonfuls of the salt are placed in a Hessian 
crucible and heated over a Berzelius lamp, the patient 
sitting in front of the apparatus and inhaling the vapor ; 
the chamber soon becomes filled with the fumes of sal 
ammoniac, and for some time after their disengagement 
has been discontinued, the invalid remains in the 
strongly-impregnated atmosphere. 

Direct inhalations give better results than breathing 
the strongly-impregnated atmosphere of a room in which 
the fumes are being disengaged. Paroxysms of cough, 






251 



with profuse expectoration, ensue only during the earlier 
sittings ; later, there results merely a sensation of 
warmth in the air-passages. 

Lewin, of Berlin, devised a chemical process for pro- 
curing the vapors of sal ammoniac in a nascent state 
without the employment of heat or fire, which latter 
method, besides being inconvenient, evolves the fumes 
too rapidly and too profusely, thereby filling the cham- 
ber with the fumes, and often provoking cough, &c. 

Fig. 12.* 




Lewin's apparatus for the inhalation of vapors of sal ammoniac. (From Lewin.) 

This apparatus (Fig. 12) consists of a series of three 
Wolfe's bottles. One of these contains liq. ammonias 
caustici, another pure muriatic acid, and the third bottle, 

* a, glass vessel containing strong aqua ammonia? ; &, glass ves- 
sel containing muriatic acid ; c, glass vessel containing distilled 
water, slightly acidulated ; d, rubber tubing, to which is attached 
the mouth-piece ; e, /, connecting glass tubes ; g, h, glass tubes for 
admittance of atmospheric air. 



252 THE INHALATION OF MEDICATED 

which is filled with water, receives a tube from each of the 
other bottles, these tubes reaching to the bottom of the 
water, while from a third opening in the cork the vapor 
extrudes through an exit tube, to which a mouth-piece 
is attached by India-rubber tubing. Now, as the effort 
of inspiration draws the liquids from the first two bottles 
into the third bottle, their ingredients combine to form 
the sal ammoniac vapor, which, during its passage 
through the water, becomes cleansed of impurities. If 
it is desired to medicate the nascent sal ammoniac with 
creasote, or an oleo-balsamic mixture, or bitter almond 
water, &c, all that will be necessary, will be to add 
it to the water in the third bottle. 

Dr. Pasch (Preuss. Vereinzeitung, 1862, 19, quoted 
by Lewin, p. 200) places a drachm of liq. ammon. caustici 
in a saucer, in which he places a watch-glass containing 
3j — 5ss of pure muriatic acid. White fumes of sal am- 
moniac are immediately evolved, and, as in other cases, 
may be inhaled with or without the use of a funnel, to 
direct them into the mouth. A great excess of ammo- 
nia is produced by this method, but it is not considered 
injurious. There always remains a quantity of carbonic 
acid gas in the lungs of catarrhal patients which is not 
exhaled, and which, remaining in the minutest bronchi, 
becomes converted into carbonate of ammonia as the sal 
ammoniac reaches it. 

I have often instructed patients merely to place a 
pinch of the salt upon an iron spoon and hold it over 
the flame of a gas or spirit-lamp ; the fumes are evolved 
in a few moments, and the spoon can be removed and 
the fumes inhaled until evaporation ceases, when the 
process is to be renewed until the required amount has 
been employed. 



AIRS, GASES, AND VAPORS. 253 

I can testify to the extreme value of these inhala- 
tions in cases of dryness of the fauces, even when of 
several years' standing, as met with in salesmen and 
others, whose mouths are more or less frequently open, 
and who, by the nature of their employment, are ex- 
posed to variations of temperature ; also in the dryness 
of the fauces of cooks, bakers, and others who are con- 
stantly breathing a heated atmosphere ; also in chronic 
pharyngitis; in the commencing stage of bronchitis, to 
induce free secretion ; in snuffles, naso-pharyngeal ca- 
tarrhs, &c. 

Inhalation of Vapors from Opium, and other narcotics. 

Opium, as is well known, is extensively inhaled in 
the East for sensual purposes. The Chinese place a 
portion of the extract, the size of a pea, into the bowl 
of a pipe, which is heated over a flame for a time, and 
then the opium is set on fire and the smoke forcibly in- 
haled. 

Dr. Snow's method is to place the required quantity 
of the extract, in the form of a pill, upon the capsule 
of his inhaler, described on pages 179 and 180, and 
then the spirit-lamp is lighted beneath ; the patient be- 
ginning to inhale immediately, and continuing to do so 
until volatilization ceases, the process usually lasting 
about ten minutes, and leaving as residue a porous car- 
bonized mass. 

Morphia, in doses of half a grain, may be used for 
inhalation in preference to opium, than which it is said 
to be pleasanter, inasmuch as the extract of opium sup- 
plies some smoke in addition to its active principles. 
The morphia is mixed with dry plaster of Paris to in- 
crease its bulk. 

22 



254 THE INHALATION OF MEDICATED 

Extract of stramonium has been used by inhalation 
in the same manner as extract of opium, in cases of 
asthma, and with asserted relief. 

Inhalation of vapors of stramonium was first intro- 
duced by Ziegler, and has been highly extolled by Mar- 
tin Solon, Andral, Trousseau, and many other Conti- 
nental authorities. It has been employed a good deal 
in this country, though not much positive information 
has been recorded. These vapors are also said to give 
relief in the exhausting cough and impeded respiration 
of phthisis ; and in dyspnoea from any cause. 

The dried leaves, or the fibres of the root may be 
smoked, alone, or with tobacco if the patient is accus- 
tomed to tobacco, either in a pipe, or a cigarette ; or 
cigars may be steeped in a strong decoction ot stramo- 
nium and then dried until fit for smoking. 
. As ordinarily smoked, it is doubtful whether the 
remedy gains access into the lungs, but if the smoke, as 
it issues from the mouth after the puff of the smoker, is 
inspired, it will then be drawn into the lungs and the 
effect will be more prompt ; otherwise it does not enter 
the larynx, and the effect is due to absorption by the 
mucous membrane of the mouth and pharynx. 

Belladonna, employed in a similar manner, has been 
recommended by many of the same authorities for the 
cure of spasmodic asthma ; it is sometimes mixed with 
tobacco and smoked, and sometimes the vapor from an 
infusion in water is inhaled. 

Other narcotics have also occasionally been employed 
by inhalation for similar purposes. 

Inhalation of Camphor. 
This substance was probably first employed by inha- 



AIRS, GASES, AND VAPORS. 255 

lation by the Arabian physician Avicenna. In the form 
of vapor, camphor is sometimes inhaled in asthma, croup, 
spasmodic coughs, and chronic catarrhal affections ; and 
there is no doubt that its constitutional impression may 
be obtained in the same way. It may be inhaled by 
means of an ordinary inhaler, placed in water more or v 
less heated, to favor the volatilization of the camphor. 

M. Raspail recommends that a small tube, a quill, 
for example, should be filled with the coarsely-powdered 
medicine, and loosely closed at each end, so as to admit 
the passage of air, and that this should be used in the 
same manner as a cigar, but without burning. In the 
inhalation of camphor, care must be taken to arrest the 
process when signs are exhibited of its acting on the 
brain. 

A piece of camphor held before the nostrils, so that 
its vapor may be snuffed up into the nasal passages, is 
sometimes beneficial in coryza. Powdered camphor has 
been recommended to be used in the same way, and for 
the same purpose, as well as for the relief of various 
spasmodic or catarrhal affections of the air-passages. 
( Wood's Therapeutics and Pharmacology, Phila., 1860, 
vol. i, p. 714.) 

A drachm or more of the tincture of camphor may 
be placed in an ounce of water, and inhaled with the 
watery vapor evolved by a. spirit-lamp. 

Inhalations of the vapor of camphor were much em- 
ployed by Dr. Bodtcher of Copenhagen. 

The inhalation of vapors of camphor with those of 
iodine have been used successfully by Prof. A. P. 
Merril, now of New York. [Memphis Medical Re- 
corder, March, 1855, p. 228.) 



256 THE INHALATION OF MEDICATED 

Inhalation of Tobacco Smoke. 

In those who by habit have not lost their suscepti- 
bility to the effect of this plant, the inhalation of the 
smoke from tobacco will often serve a good purpose in 
nervous affections of the respiratory organs. It has 
thus been recommended in ordinary spasmodic cough, 
in asthma, in phthisis, and also in spasmodic croup. 

Lime Inhalations. 

Dr. A. Geiger, of Dayton, Ohio, administers lime- 
water by inhalation, — or rather vapor of water containing 
small particles of lime in suspension, — by pouring hot 
water upon small pieces of unslacked lime ; the ebullition 
is such in the process that a profusion of minute par- 
ticles of the lime becomes detached and forced up with 
the steam arising from the vessel in which the slacking 
is going on, and remain with it in suspension, so that 
the compound can be readily inspired. 

Dr. Geiger, after narrating a very interesting case of 
diphtheritic croup in which large portions of membrane 
retaining the cast of the entire trachea were coughed 
up, and a portion of which he found to become dissolved 
in lime-water (Med. and Surg. Reporter, Phila., March 
24th, 1866), continues : "I determined to try the effects 
of the lime in the next case of diphtheria, or pseudo- 
membranous croup, occurring in my practice. The first 
case that presented itself was one of croup, in a boy 
about four years of age (son of Irish parents), residing 
some two miles from the city. The boy had already 
been sick two days before my visit. When called, I 
ordered the father to take out with him some unslacked 
lime, which he did. Upon my arrival at the house, I 



AIRS, GASES, AND VAPORS. 257 

found the patient sitting up in bed ; severe and distress- 
ing dyspnoea ; the face and body covered with perspi- 
ration from his efforts to get his breath. The usual 
harsh, dry cough, and the symptoms all indicating the 
last stages of pseudo-membranous croup, I determined 
to try alone the effects of the lime, as I saw no hope in 
any other treatment. But in what way could I bring 
it in contact with the membranous formation to dissolve 
it ? I hit upon the following expedient : I placed some 
unslacked lime in a saucer, and then, after throwing a 
cloth over his head, held the saucer under, so that he 
was compelled to breathe the fumes arising from the lime 
in the process of slacking. I retained it for a few 
minutes and then removed it. The breathing was some 
easier, and directly he expectorated a large quantity of 
tough mucus and phlegm, and was very much relieved. 
In this process, the steam arising from the lime in slack- 
ing, contains in it particles of lime which are thus, by 
inhalation, brought in contact with the membrane in 
the windpipe. I ordered lime-water and milk to be 
given internally, and the inhalations to be repeated in 
the same way, whenever the symptoms of suffocation 
w T ere severe, and that the father should report to me 
in the morning the boy's condition. 

" He came in the following morning, said i he was 
much better ; that the night before, after again inhaling 
the fumes of the lime, he had vomited up a lot of tough 
stuff, and got better right away.' I prescribed a ca- 
thartic to be given him, and the fumes of the lime, if 
he choked up again. I saw the patient no more. The 
father reported from day to day that he was getting bet- 
ter, and finally, that he could ' eat as much as ever.' ' 

Dr. Geiger, in the same communication, reports 
22* 



258 THE INHALATION OF MEDICATED 

another case of a fleshy little boy, three or four years 
of age, attacked two days previous to his visit. There 
was hard breathing, stridulous cough, with evidence of 
the formation of membrane, though to less extent than 
the case above. A purge was ordered, and directions 
given how to employ the lime inhalations. Visiting 
the child again in a few hours, he found the difficulty in 
breathing quite relieved ; the mother reporting that 
the lime had acted like a " miracle ;" that after breath- 
ing the fumes for a few minutes, he vomited freely and 
was at once relieved. On the day following, the child 
was so well that further medication was unnecessary. 

Dr. Geiger also states that Dr. 0. Crook, of the 
same city, reported six cases of diphtheria and mem- 
branous croup, in which the fumes of lime and lime- 
water were used, five of which recovered. 

Dr. Geiger reports another successful case in the 
same journal for March 10th, 1866. 

Dr. Alexander J. C. Skene, of Brooklyn, N. Y., 
reports {Med. and Surg. Rep., Dec. 22d, 1866, p. 527) 
that he has tried the inhalation of lime-water broken up 
into spray by Richardson's Spray Producer, in several 
cases of croup, and believes that he has observed marked 
advantage derived thereby. 

Dr. Thomas Byrnes, of Walcott, Iowa {Med. and 
Surg. Reporter, Philadelphia, July, 1866, p. 26), reports 
a case of diphtheria in a child seven years of age, in 
which, when he was called to the case, the tonsils were 
large, and the mucous membrane of a bright red color, 
a small patch of membrane covering the left tonsil. The 
constitutional symptoms were very slight. He swabbed 
the throat with tr. ferri chloridi, and administered five 



AIRS, GASES, AND VAPORS. 259 

drops internally every hour. The following morning 
the tonsils were covered with false membrane, which 
had ascended to the palatine arches. Small patches 
were visible on the uvula also. The cervical and sub- 
maxillary glands had become very much swollen, and 
painful to the touch. The lime was prepared for inha- 
lation, as directed by Dr. Geiger, and it soon exerted 
its beneficial effect. Small patches that covered the 
uvula were entirely dissolved, and those on the tonsils 
were diminished in size. The inhalations were continued 
at intervals of four hours. Towards evening, the false 
membrane had entirely disappeared, but returned again 
the next day and was again removed by lime inhala- 
tions. The systemic affection in this case was combated 
by supporting measures and the internal administration 
of iron. 

Dr. C. V. Moore, of Stillwater, New Jersey, writes 
to the Med. and Surg. Reporter, of Philadelphia, Sep- 
tember 5, 1866, p. 224, as follows : " I have recently 
had two severe cases of diphtheria. In one the disease 
had invaded the larynx, causing loss of voice, croupy 
cough, and paroxysmal attacks of suffocation and res- 
piration. Both cases were promptly relieved, and cured 
simply by the internal administration of small and oft- 
repeated doses of permanganate of potassa, and the in- 
halation of vapor of slacking lime. The relief from the 
inhalation was very marked, and the result was gratify- 
ing, both to the little sufferer, the friends, and most as- 
suredly to the attending physician." 

These cases were sporadic. Internal treatment, milk, 
and beef tea. 

Acting Assistant Surgeon Henry McElderry, Uni- 
ted States Army (Phila. Med. and Surg. Reporter, 



280 THE INHALATION OF MEDICATED 

April 28, 1866), reports a case of diphtheria, in which, 
in addition to supporting systemic treatment, the inha- 
lation of lime with steam, from the action of hot water 
on unslacked lime, was employed with the successful re- 
moval of rapidly-spreading diphtheritic deposit on the 
left tonsil and on the arches of the palate on that side. 
He writes that the instantaneous relief given by the in- 
halations, when he has seen so many remedies signally 
fail in diphtheria, has led him to attribute the very for- 
tunate and successful issue in this case entirely to their 
influence. He has never seen any remedy act with 
more promptness or satisfaction than the lime inhala- 
tions did in this case. 

Many other cases have been reported subsequently, 
confirming the statements and experiments of Dr. 
Geiger. 

Inhalation of Arsenical Vapors. 

The vapors from arsenic are known to produce cer- 
tain poisonous effects upon those unaccustomed to them. 
They were formerly used in the East for medicinal pur- 
poses, and their employment has recently been revived 
by Trousseau, who employed cigarettes made from bib- 
ulous paper saturated in a watery solution of arsenite 
of soda, 5ss-j to the ounce, in the treatment of chronic 
bronchial affections, and in phthisis. 

Inhalation of Mercurial Vapors. 

The inhalation of mercurial vapors has been em- 
ployed for ages in Arabia and in India for the produc- 
tion of salivation. 

Fracastori tells us [Copland, on Bronchitis, 1866, 
p. 133) that inhalations of vapors from cinnabar were 



261 



used at a very early date in the treatment of constitu- 
tional syphilis. 

The vapors from mercurial cigarettes have been used 
with advantage (Stille's Therap., vol. ii, p. 694) in 
cases of chronic thickening of the vocal cords, ozsena, 
nasal polypus, and catarrh of the Eustachian tube ; the 
cigarettes for which purpose may be made according to 
the following directions, originally suggested by Trous- 
seau : Take nitrate of mercury and strong nitric acid, 
of each fifteen grains, distilled water a sufficient quan- 
tity ; mix the acid and water, add the nitrate of mer- 
cury, and dissolve by a gentle heat ; saturate with the 
liquid a sheet of thick white blotting-paper, six inches 
by eight in size, and dry it ; before it is entirely dry 
cut the paper into suitable strips for making tubes about 
one-eighth of an inch in diameter, and secure with gum ; 
the interior of the tube may be stuffed with tobacco for 
those who are accustomed to smoking, but this addition 
it is better to dispense with ; the paper, when dry, will 
burn steadily, and its smoke, on being drawn into the 
mouth, should be directed upon the seat of the disease. 

Dr. Polak (Wiener Medic. Woehenschrift,1860,l$o. 
36) writes of the mercurial inhalations employed in the 
Orient for the treatment of syphilis. He says that in 
Persia the readiest method of curing syphilitic affections 
is by means of inhalation. There is added to the moist- 
ened narghile-tombac, a trochiscus of cinnabar, and a 
pipe thus prepared is smoked by the patient once or 
twice a day. 

The ordinary formula for the pastille is as follows : 
Cinnabar, 2 muskals(lmuskalis equal to 66 grs. apothe- 
caries' weight) ; catechu, 2 muskals ; borax, J muskal ; 
Lawsonia 2 muskals ; china nodosa, 3 muskals ; com- 



262 THE INHALATION OF MEDICATED 

bined with mucilage of gum arabic, and formed into 12 
troches. Another formula is cinnabar 2 M., mercury 2 
M., leaves of cannabis indica 3 M'., made with mucilage 
into 14 troches. 

One or two of these pastilles is to be smoked daily, 
and in the following manner : The smoke is inhaled into 
the lungs, retained there for a few moments, and then 
expired either through the mouth alone or through the 
mouth and nose together. Generally, a moderate mer- 
curial stomatitis ensues after the eighth or tenth inha- 
lation, which is a sign for discontinuing the process. 
During the treatment the patient must rinse out the 
mouth frequently, and be careful to observe great clean- 
liness. The diet consists of milk with sugar, rice and 
milk with sugar, also sheeps-feet jelly. Salt food, acids 
and fruits are interdicted. The mercurial stomatitis is 
treated with powdered sumac, with catechu, or the 
tabaschis (bambus magnesia) with gulnar (full flowers of 
the pomegranate). According to these investigations 
of Dr. Polak, no other method is comparable with that 
of these inhalations for the prompt treatment of syphil- 
itic affections of the throat. 

Inhalation of the Vapor of Chloride of Copper. 

Dr. Th. Clemens, of Frankfort-on-the-Main, has 
communicated several articles to the Deutsche Klinik, 
1865-6, on the use of the vapor from a chloride of cop- 
per by inhalation, and as a disinfectant. He asserts 
that it is an established fact, supported by experience, 
that workers in copper mines and in copper fabrics 
remain protected against the cholera poison. This led 
him to the employment of these vapors in the treatment 
of cholera, in connection with the internal and external 



AIRS, GASES, AND VAPORS. 263 

use of the remedy. The vapor is produced by heating 
a solution of the chloride of copper, a drachm to the 
pound of alcohol, with the addition of two drachms 
of chloroform. He has used it successfully as a disin- 
fectant in crowded hospitals, and it has proved effectual 
in epidemics of measles and scarlet fever. He has used 
the vapor by inhalation successfully in one case of pul- 
monary gangrene, and in two cases of pulmonary tu- 
berculosis. 

Inhalations as pursued by the Persians. 

Lewin (p. 209) copies from the Allg. Med. Central 
Zeitung, 1863, ISTo. 23, an interesting account of the 
method of inhalation pursued by the Persians, as nar- 
rated by Dr. Polak. This consists in smoking the 
fumes of certain medicinal agents through their nar- 
ghile, a smoking apparatus, by means of which the 
smoke passes through a vessel containing cold water, 
before it reaches the mouth. The material to be em- 
ployed medicinally is mixed with their smoking tobacco, 
which is made into moistened masses and inserted into 
the plaster bowl of the narghile, and then burning coals 
are laid upon it. The material is slowly consumed, and 
the smoke in passing through the cold water receptacle, 
is not only cooled, but also deprived of a portion of its 
narcotic or other properties. Dr. Polak found that the 
inhalation of cinnabar was very well borne, even by 
young children ; that six to eight strong pulls produced 
a slight sensation of approaching syncope, continuing, 
however, only for a short time, and allowing the opera- 
tion to be repeated by the next day. 

In cases of chronic catarrh and bronchitis, Dr. Polak 
employed gum ammoniac, gum galbanum, &c ; in spas- 



264 THE INHALATION OF MEDICATED 

modic and hysterical affections, assafoetida ; in ischias, 
turpentine with pistacia lentiscus, or mastic, with good 
results, or at least without injurious effect. In addition 
they could employ quinine, salicine, even narcotine and 
digitalis ; and many mineral substances, as borax, sal 
ammoniac, &c. 

By smoking the tobacco, a condition of relaxation 
can be induced, advantage of which may be taken, the 
same as the narcosis from chloroform, for the reduction 
of luxations, the reposition of hernias, &c. The plant 
tombak, employed by the Orientals, is one of the Ni- 
cotians, and very similar to our own tobacco ; it has a 
red leaf, grows favorably in sandy soils, &c, &c. 

Inhalations of the Vapor of Hot Water. 

Inhalations of the vapor from hot water are very 
serviceable in many states of laryngeal inflammation, 
especially in cases of croup, where the supply of watery 
vapor perhaps prevents the congelation of pseudo-mem- 
brane, and keeps the exudation in a fluid state, and thus 
more readily expectorated. 

It is not improbable that all the benefit from the 
inhalation of warm lime-water in croup acts in this way, 
affording moisture to the exuded matters, which in their 
congelation must part with some of their watery con- 
stituents. 

After the performance of the operation of trache- 
otomy, it has been found serviceable to maintain a warm 
and moist atmosphere about the patient. ' 

It is well known that in many pulmonary complaints, 
accompanied with more or less distress in breathing, 
advantage will follow the warming and moistening of 
the air by keeping a current of steam rising from a 



265 



vessel of water kept boiling for that purpose. The 
warm moisture inhaled acts upon the irritated mem- 
branes with the same soothing influence exerted upon 
external inflammations by warm fomentations, and thus 
the disposition to cough is lessened, expectoration is 
facilitated, &c. 

Warm steam, with camomile flowers and a little ether 
has been recommended in asthma by Dr. Eberle, and 
also the inhalation of vapor of warm water and vine- 
gar, in cynanche tonsillaris, and tracheitis. 

Dr. Mackintosh recommends the inhalation of hot 
vapor in croup, and in scarlet fever. 

The vapor of medicated waters may be employed 
medicinally by inhalation ; thus, Boerhaave employed 
the vapor of water distilled over elder flowers, as a 
remedy in pulmonary catarrh. 

The vapor from vinegar thrown upon hot water, 
facilitates dislodgement of mucus, which can then be 
more easily expectorated. The vapor of vinegar with 
boiling tar, was employed at one time by Dr. M. 
Baillie, of London, in chronic pulmonary complaints. 
Dr. Pringle (E. J. Coxe, Treatise on Inhalation, Phil., 
1845) attested the good effects he had observed in pleu- 
ritis and pneumonia from causing his patients to breathe 
over the steam of hot water, a practice recommended 
by Boerhaaye and Van Swieten, and confirmed in 
repeated trials by Dr. Huck, who found it more bene- 
ficial when the phlegm was viscid, as also more grate- 
ful to the patient by adding a small portion of vinegar ; 
and Dr. Rush, in editing Dr. Pringle's work, says 
that too much cannot be said in favor of this simple 
and powerful remedy, for he has seen patients snatched 
from the jaws of death by it. 

23 



266 THE INHALATION OF MEDICATED 

Dr. Tweedie (Dis. of Resp. Organs) says the inha- 
lation of steam in some cases rendered slightly stimu- 
lant and alterative by the addition of camphor, turpen- 
tine, or the balsams, has been found useful in promoting 
secretion from the diseased membrane. He recommends 
also, the use of sedatives, and antispasmodics, as bella- 
donna, camphor, ether, and opium, by inhalation in 
chronic laryngitis. 

Dr. Eberle recommends warm steam, with camo- 
mile flowers and a little ether, in asthma ; warm water 
and vinegar in cynanche tonsillaris and trachealis. 

Winteringhausen, though disapproving of fumiga- 
tions as advised by Bennet, Mead, and others, acknowl- 
edges the advantages derived from the inhalation of the 
steam of hot water, medicated vinegar of squills, &c. 

The value of inhalations of steam in cases of poison- 
ing by corrosive vapors is submitted to the profession by 
Samuel P. Duffield, Ph.D., who in the Detroit Re- 
view of Medicine and Surgery, gives the following suc- 
cessful treatment of poisoning by bromine inhalation : 
The corrosive action of the bromine was such that the 
glottis had closed with a spasm, and did not yield will- 
ingly. The patient was brotfght near to a steam-pipe, 
the mouth held open, and the steam thrown from some 
distance, so as not to burn him, into his mouth and 
over his face. It had the desired eifect, and the patient 
was subsequently sent home. The steam inhalations 
were continued for some time, and the patient re- 
covered. [The Medical Record, ~New York, Sept. 16th, 
186T, p. 323.) 

Medicated Atmospheres. 
In addition to the methods of direct inhalation, in- 



AIRS, GASES, AND VAPORS. 267 

direct inhalations have often been employed, by medi- 
cating the atmosphere in which a patient usually re- 
sides, as has been alluded to incidentally. The method 
has been at several times resorted to as a regular cura- 
tive process in the treatment of chronic pulmonary af- 
fections. Bartolinus endeavored in this way to keep 
sitting apartments medicated with vapors, as substitutes 
for voyages to special climates, for those unable to 
leave their homes. 

Thomas Beddoes recommended that the apartments 
usually occupied by consumptives should communicate 
with cow-houses, stables, &c, so that the atmosphere 
should be continually impregnated with the warm am- 
moniacal emanations; and this plan of treatment was 
at one time considered highly successful, but it soon 
fell into disrepute, and subsequently into disuse. Thus, 
also, residences near tanneries, have at various times 
been recommended for the purpose of supplying an at- 
mosphere more or less constantly impregnated with va- 
pors which have been considered remedies of great 
value in the treatment of pulmonary affections. 

While this work was in press, I received, too late for 
incorporation in a more appropriate place, a letter from 
Dr. S. Waterman, Surgeon to the Metropolitan Police, 
New York, in which he speaks very highly of aromatic 
alcoholic inhalations. He says : "I have been in the 
habit for many years of making use of aromatic alco- 
holic inhalations, and I have no hesitation in saying 
that they are of the most signal service when properly 
employed. I have used for this purpose the best c eau 
de cologne,' that of Maria Farina, which I mix in tea- 
spoonful quantities with boiling water on the stove in 
winter, and on a gas-stove in summer. It creates an 
atmosphere highly impregnated with the aroma of the 



268 RESPIRATORY DIET. 

volatile oil contained in the preparation, and is willingly 
inhaled by the patient. I have used these inhalations, 

" 1st. In the more advanced stages of croup, when 
from the imperfect decarbonization of the blood the 
nervous powers begin to fail, and paralysis of the nerves 
of the lungs is to be feared. In this state the inhala- 
tions act as a local stimulant, invigorating the nervous 
power, and often overcoming that dangerous state when 
no other remedy would do so. That these inhalations 
exert, also, a beneficial effect upon the nervous distri- 
butions of the entire mucous membrane of the fauces, 
larynx, trachea, and bronchi, in these cases, I now en- 
tertain no matter of doubt. 

" 2d. In bronchial disorders dependent upon a relaxed 
state of the mucous membrane, these inhalations have 
often proved highly useful. For adults they may be 
continued for days and weeks. They sometimes cause 
violent cough ; but it is just in such cases, where they 
exert a stimulating effect upon the mucous surfaces, 
that their effects will be found salutary." 

Respiratory Diet. 

In 1848, Sales-Girons suggested the regularly sup- 
plying diseased lungs with a respiratory pabulum, suit- 
able to their condition, on similar grounds to those 
defining suitable diet in diseases of the digestive organs, 
and this he called a respiratory diet. A piece of resin 
or balsam, or whatever was intended to medicate the air, 
was placed within a respirator, to be worn in front of 
the patient's mouth, thus keeping him in the same at- 
mosphere all day long, and enabling him to attend to 
his business without exposure to the unmitigated oxygen 
of the atmosphere, often prejudicial in many diseases of 
the pulmonary organs. 



RESPIRATORY DIET. 269 

He maintains [Gazette Hebdomadaire, February 17, 
1860, p. 108) that respiration is susceptible of diet as 
easily as digestion ; and for the purpose of supplying 
this diet, he employs various substances, placed in a 
little apparatus, which the patiervt carries about him 
the greater part of the day, applied above the mouth 
and nostrils, to modify the atmosphere before it gains 
access to the respiratory tract. He contends that the 
respiratory diet is in accordance with a theory of rela- 
tions between the living organism and the atmosphere, 
or the theory of relations of the lungs with oxygen. 

In the discussion which ensued upon Bouillaud's 
report upon the work of Sales-Girons [Gazette Hebdoma- 
daire, January 4, 1861), M. Fontan put the query 
whether there was not in this production of Sales- 
Girons, the germ of a grand discovery, that of a third 
state of oxygen, oxygen negatively electric, or sub- 
oxygen, in contradistinction to oxygen positively elec- 
tric, ozone or sur-oxygen, and ordinary oxygen, or 
neutral oxygen. 

Prof. Dickson {Elements of Medicine, 1855, p. 624) 
says we would anticipate some soothing influence from 
the inspiration of air made to contain a less quantity of 
oxygen, which is generally regarded as a stimulant. He 
refers, however, to atmospheric mixtures with nitrogen 
and hydrogen, and with carbonic oxide or carbonic acid ; 
and accounts in a similar way for the advantages said to 
have been derived by some consumptives, from residing 
in stables with cattle, so much in vogue in England in 
the time of Darwin and Beddoes. 

This method of keeping up a peculiarly medicated 
atmosphere is much the same as Sales-Girons' respira- 
tory diet. 

23* 



ON INHALATION. 



PART III. 

THE INHALATION OF POWDERS. 

CHAPTER I. 

THE INSUFFLATION OR INHALATION OF POWDERS IN 
AFFECTIONS OF THE RESPIRATORY ORGANS. 

The earliest employment of powders by insufflation, 
in the treatment of diseases of the air-passages, has been 
ascribed to iEscuLAPius, who, according to Galen, was 
accustomed in cases of angina to blow an astringent 
powder into the larynx by means of a bent reed. 

Aretjeus, who flourished in Cappadocia in the latter 
part of the first century, is said to have used a similar 
instrument and for the same purpose, especially in the 
laryngeal complaints of children ; while in our own 
days, the method has been reintroduced into practice 
by Bretonneau, Trousseau, and Belloc, followed by 
many others, who have devised instruments of various 
form and mechanism for the propulsion of such powders. 
Trousseau's instrument consists of a glass tube of con- 



ETC. 271 

venient size, within one aperture of which is to be in- 
serted from three to four grains of the powder to be 
used ; the other end is placed as far as possible within 
the mouth of the patient, who closes his lips upon it 
and takes an inspiration through the tube. Trousseau 
recommends the medicinal powders to be rubbed up 
with sugar of milk, to give them sufficient body. His 
formulae are, for bismuth, 1 part to 1, 2, or more of 
the sugar of milk ; for alum, 1 part to 2 ; for acetate 
of lead, 1 to 7 ; for calomel, 1 to 12 ; for red precipi- 
tate, sulphate of zinc, and sulphate of copper, 1 to 36 ; 
for nitrate of silver, 1 to 24—72. He employed the alum 
and bismuth in relaxed conditions of the mucous mem- 
brane, unattended with marked inflammation ; the salts 
of lead and copper, in cases of considerable inflamma- 
tion ; nitrate of silver, in cases of known or inferred 
ulceration ; the mercurial preparations, in syphilitic 
cases, and also in non-specific ulcerations. The insuf- 
flations were made daily, or every other day. 

Prof. Burow, of Koningsburg (Deutsche Klinik, 
1853, No. 21) was in the habit of employing in this 
manner, nitrate of silver, three grains to the drachm 
of sugar of milk, in chronic laryngitis ; and reported a 
number of cases of several years' standing, with almost 
complete aphonia, which were cured in a few weeks, 
with restoration of the voice even to purposes of vocal 
music. Finding with many of his patients an inability 
to inhale the powder by the methods previously recom- 
mended, and that in some cases the powder was actually 
blown out of the tube in expiration, he devised a special 
contrivance, composed of two parallel tubes, one fur- 
nished with a valve, so that the powder could not be 
blown out by expiration, but was compulsorily inhaled 



272 INSUFFLATION OF POWDERS 

in inspiration. The quantity of the powder employed 
by him was as much as could be put in the nib of an 
ordinary steel pen ; and this amount was used daily. 

Pserhofer, of Vienna, treated not only laryngeal, 
but also bronchial and pulmonary troubles in this way, 
and also employed the respiratory tract for the intro- 
duction of medicines in the treatment of affections of 
other organs (Schmidt's Jahrb., 1856). 

Ebert, of Berlin, placed the powder in a steel pen, 
which he placed half-way within a quill open at both 
ends, and inserted the quill within the mouth in such 
manner that the pen should lie over the root of the 
tongue, when the patient, closing his lips over the quill 
and compressing his nostrils, inhaled suddenly and 
strongly. He found the patients' first attempt usually 
unsuccessful, the powder only getting upon the base of 
the tongue and about the pharynx, so that when nitrate 
of silver was used, the peculiar metallic taste was per- 
ceived in these parts ; but generally after the second 
or third attempt, the powder was more or less thor- 
oughly inhaled, as evinced by spasm of cough, burn- 
ing sensation in the larynx, &c. A number of cases of 
laryngitis are narrated, some in young and delicate 
females, in which satisfactory beneficial results followed 
this treatment. For details of twelve cases, see Lewin, 
op. cit., p. 126 to 136. 

Lewin, of Berlin, uses a small tubulated retort for 
the inhalation of powders, a small tube passing through 
the stopper to the bottom of the retort in which the 
powder is placed, the patient inspiring forcibly through 
the beak of the apparatus. 

The most convenient insufflator that I know of is 
that of Rauchfuss, which consists of a properly shaped 



IN DISEASES OF RESPIRATORY ORGANS. 273 

tube, with a gum ball for the purpose of propelling the 
powder forwards ; the powder is inserted into a slot in 
the tube, over which a smaller tube slides after the intro- 
duction of the medicine, which can be propelled in any 
direction desired, by arranging the apertures of exit at 
the distal extremity of the tube. 

Chambers, Fournie', and many others, have devised 
instruments for this purpose. 

Dr. T. K. Chambers, of London {Lancet, 1848), 
recommends the inhalation of a light innocuous pow- 
der, with which the required medicinal agent may be 
mingled. He found most suited to his purpose the pollen 
of the lycopodium (club-moss), first allowed to imbibe 
as much as it would take up of a saturated solution of 
the substance to be employed (in the cases narrated, 
nitrate of silver and sulphate of copper, or a combina- 
tion of the two), and then carefully dried, and after- 
wards reduced to an impalpable powder. The plan rec- 
ommended for the inhalation is, that the patient should 
introduce into his mouth, as far as may be without 
choking, the tube of a well-dried glass funnel, and draw 
in his breath strongly at the same moment that an at- 
tendant, or himself if able, dusts the powder into the 
funnel from a nursery puff-ball. To obviate the neces- 
sity for withdrawing the funnel during expiration, and 
to prevent the powder from floating about the room, an 
apparatus with a double valve, and a closed powder-box 
allowing the powder to pass only from without inwards, 
may be employed instead of the funnel. 

Prof. Dickson {Elements of Medicine, 1855, p. 624) 
thinks he has seen inhalation of the finely-levigated 
powders of cinchona, and the acetate of lead, useful in 
restraining profuse expectoration. 



274 INSUFFLATION OF POWDERS 

Prof. R. H. Thomas, of Baltimore, recommends 
{Transactions of the American Medical Association, 
1855, vol. viii, p. 591, with cut) to the notice of the 
profession the following simple and easy method of ap- 
plying nitrate of silver to the air-passages, contrived 
and adopted by his brother, Dr. John Chew Thomas, 
of Baltimore. 

Let a fine grindstone or emery-wheel be caused to 
revolve with great velocity, while a stick of the caustic 
is lightly held in contact with it. The effect will be to 
convert the caustic into an impalpable powder, which 
may be inhaled freely by the patient, who sits before 
the stone at a convenient distance ; from three to six or 
eight inhalations may be taken at a sitting, according 
to the effects, but it is recommended to desist after much 
cough is created, and the operation may be repeated 
every two or three days, according to the influence it 
exerts on the disease. 

It has been found, in Dr. Thomas's experience, to be 
well adapted to chronic inflammation of the larynx, 
trachea, and bronchi, rarely causing any more than a 
temporary irritation. He has also used it with good 
effect in recent hoarseness and slight inflammation of 
the fauces and throat. In established acute inflamma- 
tion, depletion and general treatment should precede its 
employment. 

Dr. Thomas refers to a number of instances of slight 
but persistent affections of the larynx and trachea, 
which were accompanied with weakness of voice, hoarse- 
ness, inability to speak or read for any length of time, 
which were entirely cured by the use of this means ; also 
cases of chronic bronchitis, which had proved very obsti- 
nate, yielding perfectly to the steady use of the same 



IN DISEASES OF RESPIRATORY ORGANS. 275 

agency. He does not claim that it can supersede the 
use of the sponge and caustic solution, but that in many 
of the slighter affections of the throat, it may enable us 
to dispense with the disagreeable necessity of using the 
mop, and that it is applicable to some cases to which 
the former method is not. 

Prof. Chas. Matthews describes and depicts (Am. 
Med. Times, November 24, 1860, p. 365) an instrument 
of his invention, intended to facilitate the inhala- 
tion of the smoke of powders in a state of ignition. It 
consists of two tubes of paper, to the outer of which is 
attached the mouth-piece, the powder being confined 
w T ithin the inner tube, upon lighting which the smoke is 
conveyed to the mouth through the interspace between 
the two tubes. Cubebs is preferred as the vehicle to 
give sufficient volume to the powder when employed in 
this manner, for cases where a gentle stimulus is de- 
sired; though decayed wood, pine bark, &c, may be 
employed for the purpose. 

An important point to be determined, says Lewin (op. 
cit., p. 122), in this connection, is whether the powder in- 
spired remains in the respiratory tract, and is not again 
extruded by the waving outwards of the ciliary epithe- 
lium. That this latter occurrence is generally the case, 
continues Lewin, we know very well. A large quantity 
of minute dust is continually floating in the atmosphere, 
especially in crowded cities. Now, if all this were in- 
haled, and remained in the pulmonary organs, it would 
eventually produce fatal consequences, because the bron- 
chial tubes would become more or less clogged up. Such 
a result, however, is avoided by our natural instinct of 
breathing through the nostrils, the tortuous sinuosities 
(from the shape of the turbinated bones) of which 



276 INSUFFLATION OF POWDERS. 

cavities, are provided with small hairs ; these hairs and 
the turbinated prominences catch the particles of dust 
inhaled through the nostrils, which particles are subse- 
quently ejected from time to time by a very familiar 
process. But after a certain number of nasal inspira- 
tions, we find it necessary to gape or take a deeper in- 
spiration than ordinary, for which purpose the mouth is 
more or less widely opened ; usually it is not very widely 
opened, and the soft palate not being raised very much, 
the dust taken in with the inspiration strikes the velum, 
and becoming entangled in its mucus, it is thrown upon 
the moist mucous membrane of the tongue, half arches, 
and pharynx ; the dust that has proceeded farther, is 
arrested by the epiglottis, the ary-epiglottic folds, and 
the ventricular bands or false vocal cords. If, notwith- 
standing these hindrances, some of the dust reaches the 
larynx or trachea, it is detained by the moist mucous 
membrane, and is expectorated by hawking or coughing, 
or is gradually removed by the waving of the cilia. 

This is much less the case, and in some instances not 
at all the case, when the materials inhaled are soluble, 
and dissolve in the bronchial mucus before the cilia 
can extrude them; or when the matters are specifically 
too heavy to be moved by them; or when too great a 
quantity has been inhaled; or when the mucous mem- 
brane does not possess its full strength and capabilities. 

On these grounds, concludes Lewin, it would appear 
that the inhalation of powders can be employed for the 
purposes of local therapeutics. 



CHAPTER II. 

EXPERIMENTS ON MEN AND ANIMALS, PROVING THE 
PENETRATION OF POWDERS INTO THE RESPIRATORY 
TRACTS. 

Any one can convince himself that powders can be 
voluntarily drawn at least into the upper air-passages, 
by directing the dust of some colored substance, as char- 
coal, for instance, across his mouth, and suddenly tak- 
ing a deep inspiration. The irritation produced, and the 
spasm of cough accompanying it, will be proof positive 
that some of the suspended particles have been drawn 
beyond the glottis, while an examination with the laryn- 
goscope will show that some particles of the dust have 
lodged upon the vocal cords, true and false, the greater 
proportion being spread on the anterior wall of the tra- 
chea, and very little reaching the posterior walls of the 
larynx. A large portion of the powder will, of course, 
have remained in the mouth, principally detained about 
the base of the tongue, and upon the soft palate just 
over the attachment of the uvula. 

A great many experiments have been made upon ani- 
mals who were forced to inhale powders, and in whom, 
after section, the presence of the powders has been de- 
monstrated in the respiratory organs. 

The principal experimenter in this direction has been 
Fournie, and his reports have excited a good deal of 
attention among those interested in the question. 

24 



278 EXPERIMENTS PROVING PENETRATION 

In the British $> Foreign Medico-Chirurgical Review, 
July, 1863, p. 241, we read : " Dr. Edouard Fournie 
(_Z7 Union Medicale, February 5, 1863) has clearly as- 
certained that the dust of charcoal, flint, starch, &c, 
penetrates into the bronchi, and he has endeavored to 
render the fact available in the treatment of disease. 
In order to obviate any disagreeable sensation on the 
part of the patient, he recommends the medicinal powder 
to be breathed in a special contrivance which he de- 
scribes. It consists of an oval wooden box, fitted with 
two tubes, so arranged that the patient breathes the air 
in the box mingled with the medicinal powder. Laryn- 
goscopy examination, and the black expectoration after 
the use of the apparatus, when charcoal-dust has been 
employed, proves that the dust has entered the respira- 
tory passages. The same apparatus is available for the 
inspiration of volatilized iodine, and Dr. Fournie has 
also thus employed for medicinal purposes, starch, alum, 
tannin, subacetate of lead, and nitrate of silver. The 
diseases which he has successfully treated have been 
cases of catarrh, bronchitis, and some of well-marked 
phthisis." 

Fournie inclosed the head of a coal-heaver, whose 
nostrils were first compressed by forceps (pince-nez), 
in a sack filled with a quantity of coal-dust, and then the 
sack was shaken over his head with a good deal of force. 
The man coughed and coughed, and seemed to feel very 
uncomfortable. After being allowed to breathe this at- 
mosphere for three minutes, the sack was removed and 
an examination by the laryngoscope gave the following 
result : The tongue, soft palate, tonsils, and pharynx, 
were fully covered with a thick layer of coal-dust ; the 
epiglottis, aryteno-epiglottic ligaments, and the aryte- 



OF POWDERS INTO THE RESPIRATORY TRACTS. 279 

noid cartilages, were marked with coal streaks at sev- 
eral places, and were very much reddened; there was 
only a thin black streak over the right vocal cord. An 
examination with the laryngoscope before the experi- 
ment, had shown the parts to be normal. This clean- 
ness of the mucous membrane of the larynx contrasted 
very strongly with the condition of the trachea, the mu- 
cous membrane of which, particularly on its posterior 
wall, was almost entirely covered with coal-dust. This 
experiment was repeated by Fournie upon himself and 
others, with similar results. (Lewin, op. cit., p. 121.) 

Quite recently, Dr. Moritz Rosenthal, of Vienna, 
has published the records of a series of experiments 
which he instituted upon rabbits to determine the extent 
to which pulverulent substances could be made to pene- 
trate into the respiratory organs [Schmidt's Jahrbucher, 
November, 1866, from Wien. Zeitschrift, 1866, No. 1). 
Some very finely-pulverized charcoal, sifted through a 
cloth, was placed in a double linen bag, in which a mod- 
erately-sized rabbit was confined, and the bag, with its 
contents, was then whirled round for from fifteen to 
twenty minutes, after which the animal was killed by 
section of the spinal cord, and the respiratory tract 
examined from below upwards, to avoid the conveyance 
by the shears of any of the material from above down- 
wards. The coal was found in the ventricles of the larynx, 
on the walls of the trachea, and on those of the larger 
bronchi. By the aid of a lens, it was detected in the in- 
terstitial lung-tissue, where it became still more evident 
upon microscopical examination. Sufficient reasons are 
adduced to prove that the appearances were not due to 
the pigment matter normally found in the lung-tissue 
of such animals. An animal which had been permitted 



280 EXPERIMENTS PROVING PENETRATION 

to live for several days after having been similarly ex- 
posed to an atmosphere loaded with the charcoal-dust, 
was examined, but not a particle of coal was found. in 
the larynx or trachea, although such particles were dis- 
covered under the microscope in various portions of the 
lung, and also imbedded in the muscular structure of 
the right ventricle of the heart, into which they had 
bored their way ; not, however, in that of the left ven- 
tricle. Another rabbit was compelled to breathe a mix- 
ture of coal and starch powder, for fifteen minutes, im- 
mediately after which it was killed, but afforded no 
evidence of starch, microscopically or chemically, in 
the lungs or in any other organ ; the starch had been 
detained in the mucus of the upper part of the air-pas- 
sages. A large rabbit was made to breathe for twenty 
minutes an atmosphere in which was suspended six 
ounces of carbonate of lead. Evidences of the lead 
were found in the larynx, trachea, and main bronchi; 
and the lung-tissue, when dried under the microscope, 
showed irregular masses of crystals, identical with those 
of the carbonate of lead. 

Dr. Rosenthal found that in foundries, where the 
models are sprinkled all over with graphite before being 
cast, the sputa of the workmen were black-colored and 
somewhat greasy. On laryngoscopic examination, he 
found stripes of grayish-black dust collected upon the 
posterior pharyngeal wall, and also upon the epiglottis 
and the vocal cords, the mucous membrane covering 
which structures was greatly reddened. These work- 
men are well nourished as a general rule, not liable 
to pulmonary affections particularly, and tuberculosis 
among them is rare. The irritation from the inhaled 
graphite seems principally confined to the pharynx, 



OF POWDERS INTO THE RESPIRATORY TRACTS. 281 

larynx, and upper portion of the trachea. The writer 
then goes on to recount the effect of various occupa- 
tions, where the atmosphere of the workroom is filled 
with dust, as those of bakers, grinders, apothecaries, 
&c. ; he believes that very often such substances in- 
haled, by keeping up a continued irritation of the bron- 
chial mucous membrane, &c, affect the distributions of 
the vagus, recurrent, and hypoglossal nerves ; at times, 
even to the extent of producing paralysis. 

The investigation into the diseases to which workers 
in stone, glass, tobacco, coal, &c, are subjected, by 
Traube, Cohnheim, Leuthold, Kussman, Degen, Zen- 
ker, Selbman, Koschlakoff, Felbz, and many other Teu- 
tonic physicians who have given the subject great atten- 
tion, prove, beyond the possibility of a doubt, that fine 
particles of dust gain entrance into the air-passages, 
inducing severe and often fatal affections. 



24* 



CHAPTER III. 

PATHOLOGICAL PROOFS OF THE PENETRATION OF 
POWDERS INTO THE LUNG-TISSUE. 

A case proving the penetration of particles of coal 
into the lung-tissue, from inhaling an atmosphere loaded 
with the substance, is reported in detail by Prof. Traube 
{Deutsche Klinik, 1860, Nos. 49 and 50, pp. 2 to 3|). 
This case was a charcoal carrier, set. 54, who had worked 
at his employment for twelve years, and in whose 
lungs, after death, particles of charcoal were detected 
(Schmidt's Jahrbucher, vol. 110, p. 299). For twenty 
years he had had a cough, and of late years had 
suffered with shortness of breath. For twelve years, 
and to within the last three months of his life, he had 
been almost constantly exposed to the dust of charcoal, 
and had often observed that his sputa were black. In 
his expectoration were found numerous free black par- 
ticles, of very irregular, angular shape, and sometimes 
of large size. Some of these presented structural pecu- 
liarities identifying them with the wood of the Pinus 
sylvestris. Three months before his death he was 
attacked with pericarditis, and subsequently, double 
pleuritis, and finally, gangrenous erysipelas. At the 
autopsy, the lungs were found free from structural 
lesion, but almost everywhere of a dark black color. A 
copious amount of dark serous fluid exuded on pressure, 
staining the fingers black like India-ink, and exhibiting 



PATHOLOGICAL PROOFS OF PENETRATION, ETC. 283 

under the microscope black and red particles similar to 
those which had been found in the sputa. Some of 
these particles were firmly imbedded in the pulmonary 
cells, to which they had bored their way. Prof. Traube 
believes that derangement of the ciliary action of the 
bronchial mucous membrane is essential to the accumu- 
lation of carbonaceous matter in the lungs, inasmuch 
as many persons continually inhale fine dust in simi- 
larly loaded atmospheres without apparent suffering. 

A similar case occurring in Prof. Traube's Klinik is re- 
ported by Dr. Leuthold, in the Berlin en Klinik Woch- 
ensehrift, iii, 3, 1866 (Schmidt's Jahrbiicher, Band 
132, 1866, p. 163), in which, during life, the particles 
of the coal were detected in the sputa upon microscopi- 
cal examination ; and at the autopsy, Dr. Cohnheim 
detected similar particles in the very stroma of the 
lungs, and in the bronchial glands, proving that they 
had penetrated into the air-cells and had bored their 
w r ay through the walls of the alveola. 

Dr. Peacock reports [Brit, and For. Medico-CMr- 
urgical Review, vol. xxv, 1860) the results of a post- 
mortem examination of a patient who died of millstone- 
makers' phthisis, at the age of thirty-seven, having com- 
menced work at that trade in his twentieth year. Por- 
tions of the indurated pulmonary tissue, and of the dis- 
eased bronchial glands, were obligingly examined by Dr. 
Bristowe, who furnished the reporter with the follow- 
ing notes : " The diseased portions of lung were much 
indurated, having generally an opaque whitish hue, but 
being thickly studded with a black pigment. Under 
the microscope little or no trace of original lung-struc- 
ture was visible, but the diseased masses appear to be 
made up of dense, closely-arranged, fibroid tissue, 



284 PATHOLOGICAL PROOFS OF PENETRATION 

studded here and therewith numerous irregular groups 
of black pigment, and generally with an abundance of 
transparent granules and globules of various sizes. The 
tissues were rendered comparatively transparent under 
the influence of strong acetic acid, the fibroid tissue 
becoming a little expanded, and many of the granules 
and globules disappearing. The bronchial gland pre- 
sented characters identical with those of the diseased 
lung." 

Dr. Peacock subjected portions of the indurated lung- 
tissue to ignition in the flame of a spirit-lamp. The 
white ash which remained, dissolved to a great extent 
in hydrochloric acid, and partly with effervescence ; but 
a portion was left which was seen under the microscope 
to consist of small angular transparent granules, exactly 
resembling the finer portions of the silicious dust col- 
lected from one of the workshops. Dr. Moldenhauer, 
assistant in the chemical laboratory at St. Thomas' 
Hospital, also subjected portions of the indurated lung 
to the action of fire and nitric acid, and found that a 
considerable quantity of gritty matter remained, which 
had an amorphous aspect under the microscope, and 
was inferred to be silicious. The bronchial gland did 
not contain any similar material. 

At a meeting of the Pathological Society of London, 
held May 16th, 1865, Dr. Greenhow exhibited two 
morbid pathological specimens, one being a specimen of 
diseased lungs from a case of grinders' asthma, and the 
other a specimen of coal-miners' black lung. To copy 
the account from the Transactions of the Society : 

"Specimen of diseased lung from a case of grinders' 
asthma. — The specimen has been in my possession for 
some years. It was taken from the body of a razor- 



OF POWDERS INTO LUNG-TISSUE. 285 

grinder, who had long suffered from grinders' pulmonary 
disease, but had died from an intercurrent attack of 
pneumonia. The portion of lung shown is from the 
upper lobe, near the apex ; it is consolidated, but some 
parts are harder than others, and it is intersected by a 
firm white band, apparently produced by the thicken- 
ing of interlobular tissue. It is now of a dark bluish- 
gray color, but is paler than when fresh. On exami- 
nation of a thin slice under the microscope, a few small, 
apparently crystalline bodies, * irregular in size and 
shape, were seen embedded in the tissue, which also 
contained numerous small, well-defined, black masses 
of various sizes, which gave the lung its peculiar dark 
color. On the supposition that these latter might be 
at least due to the presence of oxidized iron, a very 
thin slice of the lung was taken and immersed for some 
time in hydrochloric acid ; but on examination under 
the microscope, it was found still to present appear- 
ances identical with those already described. In order 
to determine the nature of the apparently crystalline 
bodies, a small portion of the lung was carefully incin- 
erated in a porcelain crucible ; it left a bright red ash 
which partially dissolved in boiling hydrochloric acid, 
leaving a small residue that gravitated to the bottom of 
the vessel. On examination of this residue under the 
microscope, it was found to consist partly of an amor- 
phous deposit, partly of small angular masses which 
reflected light powerfully, and polarized light trans- 
mitted through them. A portion of the residue being, 
at the suggestion of my friend, Mr. Heisch, lecturer 
on chemistry at the Middlesex Hospital, exposed in a 
shallow platinum vessel to the fumes of hydrofluoric 
acid, was entirely dissipated, proving it to be silica. A 



286 PATHOLOGICAL PROOFS OF PENETRATION 

comparative experiment was tried with a portion of 
ordinary lung (from a patient who had died in the 
Middlesex Hospital) which, when incinerated, left an 
ash not quite so red as that from the grinder's lung, 
and altogether soluble in boiling hydrochloric acid. 
The solution of the ash from both lungs gave faint in- 
dications of the existence of iron, about equal in both 
cases ; but the absence of free particles of iron in the 
grinder's lung was determined by bringing every part 
of the specimen into proximity with a delicate magnetic 
needle without causing any sensible disturbance. 

" The disease from which the patient had suffered ap- 
pears to have been chronic, or, as Rokitansky terms it, 
interstitial pneumonia, and its cause was doubtless the 
inhalation of finely pulverized grit, given doff from the 
revolving grindstone while the man was at work, and 
which, as we have seen, was found in the lung after 
death, in the form of small angular particles of silica. 

u Specimen of coal-miners black lung. — This speci- 
men, like the former, has been in my possession for some 
time. It was obtained from the body of a collier who 
had worked in the shallow and ill-ventilated coal mines 
near Wolverhampton, and was taken from the free mar- 
gin of the upper lobe. The general color of the mass 
is dark blue, almost black ; but it was quite black when 
fresh, at which time a black juice could readily be 
expressed from its substance. The pleura is thickened, 
and the lung is traversed by some firm white bands, 
apparently formed by the thickening of the interlobular 
tissue. The lung cuts toughly, and is very firm and 
solid, but not uniformly so, some ill-defined harder por- 
tions being felt in the substance when handled. Under 
the microscope, the lung was seen to be studded with 



OF POWDERS INTO LUNG-TISSUE. 287 

small black deposits, apparently irregular, both in shape 
and size, but the examination was not made until it had 
been for some time immersed in spirit. On boiling a 
small slice in strong hydrochloric acid, the black deposit 
was not affected. A portion of the lung when incin- 
erated, left a red ash, closely resembling the ash left 
from burnt coal. When boiled in hydrochloric acid, 
this ash was partially dissolved, leaving a white or 
grayish amorphous residue, which did not polarize light, 
but evidently consisted of silica, for it was dissipated 
on being exposed to the fumes of hydrofluoric acid. 

"This case appears to have been assimilated in its 
pathological characters to that of the razor-grinder. 
The lung was similarly consolidated, and traversed by 
white bands. Whatever doubt may sometimes be enter- 
tained regarding the origin of the black deposit in the 
lungs of colliers, it appears quite certain that in this in- 
stance it arose mainly from the inhalation of finely -pul- 
verized coal; for on no other supposition can we explain 
the presence of the very large amount of amorphous silica 
obtained from the incinerated lung. 

" Remarks. — The result of the examination of these 
specimens of lung accords with the history of the symp- 
toms from which the several classes of operatives ex- 
posed to inhale grit, or other heavy dust, are practically 
found to suffer. The earlier symptoms are those of 
bronchial irritation, namely: slight dyspnoea, cough, 
and scanty expectoration colored with the material in- 
haled. This ailment often proceeds so slowly and in- 
sidiously that the sufferer is scarcely aware of its exist- 
ence until it becomes aggravated by some attack of ca- 
tarrh, and more or less disables him from working. 
Hence, overlooking the previous indisposition, he, for 



288 PATHOLOGICAL PROOFS OF PENETRATION 

the most part, dates the commencement of his illness 
from the occurrence of a cold. In a great many in- 
stances, and especially those in which the dust inhaled 
is of a light description, the disease often remains bron- 
chial throughout, and presents only the ordinary char- 
acters of chronic bronchitis, with or without emphysema. 
But in other cases, and especially in those in which a 
heavy dust, such as that given off in the processes of 
razor-grinding or china-scouring, has been inhaled, 
chronic pneumonia supervenes after a time, and fre- 
quently proves fatal, either in consequence of an inter- 
current attack of acute pneumonia, or after a long 
chronic course with symptoms resembling those of very 
chronic phthisis. Dyspnoea is always a very marked 
feature of such cases, and is sometimes so extreme as 
to prevent active locomotion, even while the patient 
is still able to continue his occupation. The physical 
signs are also out of all proportion to the amount of dis- 
turbance of the general health, which, in constitutionally 
sound subjects, is much less than in those who are the 
subjects of pulmonary disease arising from constitutional 
cachexia. Sometimes, even when the complaint appears 
to be far advanced, the discontinuance of exposure to 
the determined cause, viz., the inhalation of dust, is fol- 
lowed by a most marked improvement in health." 

Prof, Zenker relates in detail (Deutseh. Arch, fur 
Klinik Med., 1866, vol. 11, p. 116) a case of an oper- 
ative, aet. 31, who had been employed during life in pre- 
paring the paper books for the gold-leaf fabric, and who 
died in 1864, after an illness of eight weeks. The powder 
employed is that known as English red, a compound of 
iron, which is used in the form of a dry impalpable pow- 
der, and rubbed into the paper with felt. The atmos- 



OF POWDERS INTO LUNG-TISSUE. 289 

phere of the workroom becomes so filled with the dust 
as, in a few minutes, to dry the fauces of strangers unac- 
customed to the atmosphere. The lung of this patient 
had a red color; and on chemical examination, Prof, von 
GoruP-Besanez found oxide of iron in large quantities 
as fine molecules in the air-passages, and to a greater ex- 
tent in the lung-tissue itself; besides, also, in the bron- 
chial glands ; and still further, showing that the par- 
ticles, after penetrating the interstitial tissue, had been 
carried onwards by the lymphatic system. 

A solution, in hydrochloric acid, of 55 grammes of the 
incinerated ash of this lung-tissue, was found to contain 
0.828 grammes of oxide of iron ; therefore, 14.5 
grammes, or about half an ounce to 1000 grammes; 
or in the proportion of three-fourths of an ounce in the 
entire lungs, which, in the present instance, weighed 
1500 grammes, the left lung weighing 720, and the 
right 780 grammes ; much in excess of the normal 
weight of the female lungs, which, according to Krause, 
is 1050, according to Dieberg, 1073 grammes. 

In order to determine the specific gravity, a compar- 
ative experiment was made with the healthy lung of a 
robust man of forty years of age, who died of another 
affection, and with the compressed lung of an old man, 
who died of pleuritic exudation, care being taken to re- 
move by frequent washing, &c, all sources of error 
which might invalidate the experiment. The result is 
shown in the following table : 

A portion of the Of the Of the 

oxidized lung; sound lung; compressed lung; 

Weighed in air, 7.210 gr. 8.810 gr. 12.02 gr. 

Weighed in water, 0.440 0.130 0.03 

Loss of weight in water, . . 6.770 8.680 11.99 

Thesp. gr. being 1.065 1.015 1.0025 

25 



290 PATHOLOGICAL PROOFS OF PENETRATION 

To demonstrate more clearly the increased weight, 
equal portions were taken from the above specimens, and 
also from the sound lung of a boy of fifteen years of age, 
which were allowed to drop to the bottom of a glass cyl- 
inder, filled with water to the height of forty-five cen- 
timetres ; when it was found that the oxidized lung fell 
in thirteen seconds, upon a first, second, and third trial; 
that the piece of sound lung from the robust man aged 
forty, fell in twenty-six seconds on the first trial, in 
twenty-five seconds on the second trial, and in twenty- 
six seconds on the third trial ; the piece of sound lung 
from the boy aged fifteen, fell in thirty seconds on the 
first and second trials ; and the specimen of compressed 
lung from an aged man fell in thirty-one seconds on the 
first trial, in thirty-two seconds on the second trial, and 
in thirty-two seconds on the third trial. 

A second case is related w T ith similar results as to the 
detection of oxide of iron in the air-passages and lung- 
tissue, in a patient who had been employed backing glass 
mirrors, the English red being used for the purpose of 
rendering the metal adherent. 

The sputa of a similar operative, examined twelve 
hours after leaving off work, were found to contain the 
oxide of iron upon chemical and microscopical investi- 
gation. 

The results of many other post-mortem examinations 
have given the same results. Thus may be mentioned 
the cases recorded by Erdmann, Lowe, Brockman, 
Pearson, Bichat, Trousseau, Laennec, and many 
others. 

Dr. L. Petrenz (Lewin, op. cit., p. 11) found stony 
concretions the size of a hazel-nut in purulent pulmonary 
cavities. 



OF POWDERS INTO LUNG-TISSUE. 291 

With regard to the black pigmentary matters found 
in the lungs of deceased coal-miners, and others who 
have worked in atmospheres loaded with coal-dust, some 
authors deny altogether their penetration into the pul- 
monary organs ; others contend that they may be in- 
haled, but, being insoluble, are expectorated ; others 
not only admit their penetration, but are of opinion 
that they accumulate, act deleteriously, and produce al- 
teration of structure. 

Virchow is one of those who contend that these ap- 
pearances are not due to the inhalation of particles of 
coal-dust; which, according to him, if inhaled, would be 
extruded with the bronchial mucus. He considers the 
affection pigmentary, and due principally to obstruction 
of the mitral valve dependent upon a chronic hypere- 
mia of the lungs, the result of a detention of the blood 
in the pulmonary veins. 

Bayle recorded two cases which he attributed to a 
circumscribed melanosis; and Laennec, in commenting 
upon this view, rather refers the black deposit, as at 
least in part due, to inhalation from the smoke of the 
lamp or other products of illumination in general use, as 
it was sometimes discovered in the lungs of nurses ac- 
customed to sit up at night with the sick. 

It is also found in the lungs of other miners, not 
colliers, who work with lamps suspended over their 
heads. 

Others, again, are of opinion that the carbonaceous 
material or lampblack thus inhaled, accumulating, 
forms a nidus for the attraction of further carbonaceous 
matter from the blood. This view seems to be worthy 
of a good deal of consideration, for it has been found 
that by washing the lungs containing such deposits, two 



292 PATHOLOGICAL PROOFS OF PENETRATION 

materials are secured — one a vegetable carbon not acted 
upon by the solvents which will readily dissolve the 
other or organic pigmentary matter. 

While it is true that much of the matters inhaled 
would be thrown out of the system with the bronchial 
secretions, it must be remembered that some portions 
will be too heavy to be cast out against gravity, by the 
mere motion of the bronchial cilia, while other minute 
sharp-pointed particles, will bore their way through the 
epithelium, and thus eventually become embedded into 
the very pulmonary tissue, as indeed appears to have 
been the case in the examples cited, similar evidence to 
which can be readily increased by adducing further 
records. 

We know, too, that workmen who remain long at a 
time in apartments filled with fine dust, — for instance, 
bakers, weavers, chimney-sweepers, artificers in stone, 
&c, — are peculiarly liable to diseases of the lungs. Thus 
Dr. Peacock, calling attention {Brit. $- 'For. Med.-Chir. 
Rev., vol. xxv, 1860, p. 215) to the form of phthisis to 
which the French millstone-makers are subject, explains 
how it is contracted. The rough working of the stone is 
effected by a steel chisel, " the pritchel," which is struck 
by a metal hammer, and the surfaces are finished by 
picking with a double-pointed steel instrument fixed in 
a wooden handle — the "bill and thrift." As the burr 
is extremely hard (it is the " French burr," situated in 
the Paris basin above the gypsum containing bones, and 
in strata of sand and sandstone, and is harder to work 
than gun-flint), every stroke of the chisel is attended by 
a flash of light and a cloud of dust, and larger or smaller 
particles of stone, forming a sharp grit, are thrown off. 
Portions of the stone and of iron from the chisel not in- 



OF POWDERS INTO LUNG-TISSUE. 293 

frequently become embedded in the hands of the work- 
men, so that the backs of the hands of those who have 
been long at the trade are studded with small bluish 
spots ; and occasionally the men sustain serious injury 
to their eyes. The mortality of these workmen is very 
great, so that of fifty workmen, about twenty will die 
of pulmonary disease within a few years, and they seldom 
live beyond forty years of age, especially if they begin 
to work at the trade in early life before their full physi- 
cal development has been acquired. Dr. Peacock found 
in four workshops forty-one workmen, of whom the 
eldest was but thirty-eight years of age, and those next 
oldest twenty-nine and twenty-eight respectively. Most 
of them had before them, on an average, but eight or 
nine years more of labor. It is a remarkable fact that 
these workmen, knowing their condition and the result 
of a continuance at their avocation, seem thoroughly 
satisfied with it. Their wages are high (5s. per day), 
their dwellings and workshops are healthy, and they 
are well clothed. They drink freely of ardent spirits, 
which is said to preserve their strength and enable them 
to exist longer. 

Prof. Dickson, in his lectures last winter in Jefferson 
Medical College, Philadelphia, teaching the causation of 
disease, drew the attention of his class to the fact that 
many diseases are necessary results of the occupations 
of civilized life, and instanced the wet and dry grin- 
ders in England, who have long been doomed to prema- 
ture old age and death, from the wearing away of the 
stone in "foam-like surges," which fill the lungs and 
thus induce fatal disease ; for a dry grinder rarely 
reaches thirty-five, or a wet grinder forty-five years of 
age; quoting the following lines from Elliot's Corn-Law 

25* 



294 



ETC. 



Rhymes, showing how these grinders, like the millstone- 
makers, continue at their trade on account of its high 
wages and opportunity for affording the means of alco- 
holic stimulation : 

" There draws the grinder his laborious breath ; 

There, coughing, at his deadly trade he bends; 
Born to die young, he fears nor man nor death ; 

Despair and riot are his bosom friends. 
Bid science on his cheek prolong the bloom ! 

He wilt not live — he seems in haste to gain 
The undisturbed asylum of the tomb ; 

And, old at two-and- thirty, meets his doom." 

As a pathological proof of the penetrability of fine 
powders into the respiratory passages, I may instance a 
number of cases occurring in a family in this city living 
over a perfumery store which caught fire. The family 
breathed the stifling smoke, and ten of them who came 
under the care of Dr. W. W. Keen, Jr., and myself, were 
attacked with severe bronchitis, with aphonia ; and for 
several days subsequent to the accident they expecto- 
rated large quantities of black sputa, which were 
nothing more nor less than the carbonaceous matters 
they were forced to inhale during the conflagration be- 
fore they could be rescued. 

Dr. Da Costa, of this city, in a foot-note to the re- 
print of his lately-published essay on Inhalation, states 
that quite recently his attention had been called by Dr. 
Fleming, of Pittsburg, to the rapidity with which men 
repairing copper work which had been used for steam, 
water, &c, become affected by the impalpable oxide of 
copper therein formed. Dr. Fleming himself, having 
been exposed for a few minutes to the same influence, 
and the quantity breathed having been very minute, was 
astonished at the great effect experienced ; constriction 
about the chest, most active salivation, &c. 



INDEX. 



Academy of Paris (Hyclrological), 14. 

(Imperial, of Medicine), 15. 
report to, on Sales-Girons' inhalatorium, 15. 
on Sales-Girons' portable nebulizer, 15. 
of Poggiale to, on the inhalation of nebulized fluids, 56. 
discussion before, on Poggiale's report, 57. 
Acidum carbolicum, 98. 

tannicum, 91. 
Alumen, 90. 

Aluminium nitricum, 91. 
Ammonia murias, 93. 

inhalation of vapors of, 250. 
Le win's inhaler for vapors of, 251. 
Angina diphtheritica, 230. 
tonsillaris, 103. 
syphilitica, 107. 
Aphonia, 142, 205, 226. 
Aqua amygdalarse amarte, 95. 
assafoetidae, 94. 
calcis, 94. 
picis liquids, 94. 
Argenti nitras, 91. 
Argentum iodidum, 94. 
Arnold, Dr. G-. J., apparatus of, 34. 
Aromatic alcoholic inhalations, 267. 
Arsenical vapors, inhalation of, 260. 
Asphyxia, 194, 196. 
Asthma, 165, 181, 249. 

* of grinders, case of, 284. 
Atmospheres, medicated, 267. 
Atmospheric air, forced inhalation of, 180-1. 
compressed, inhalation of, 182. 



296 INDEX. 

Atropine sulphas, 96. 
Axtphan, experiments of, 55. 
inhalatorium of, 13. 

Balsamic vapors, inhalation of, 236. 
Bataille, experiments of, 55. . 
Beigel, face protector of, 38. 

oxygen, inhaler of, 191. 

pocket steam nebulizer of, 38. 
Belladonna, inhalation of vapors of, 254. 
Belladonnas tinctura, 96. 
Benzine, inhalation of, 222. 
Bergson, nebulizer of, 25-8. 

Bernard, Prof. Claude, experiments witnessed by, 41. 
Briau Bene, experiments of, 41. 

treatment of cases by, 100. 
Bronchial catarrh, 113. 
Bronchitis, acute, 147, 225. 

chronic, 148, 243. 
Bronchorrhcea, 148, 215. 

Cadinum oleum, 97. 
Camphor, 97. 

inhalation of vapors of, 255. 

Raspail's inhalers for, 255. 
Cannabis indicum extractum, 95. 

tinctura, 95. 
Carbolic acid, 98, 163. 

Carbonaceous matters found in miners' lungs, 291. 
Carbonic acid gas as a nebulizing force, 34. 

inhalation of, 218. 
Cases of angina tonsillaris, 103. 

aphonia, 142-4, 205, 227, 228. 

asphyxia, 196. 

asthma, 165, 181, 199. 

bronchiectasie, 114. 

bronchitis, acute, 225. 

chronic, 113, 148-9, 225. 

bronchorrhcea, 215. 

coal-miners' black lung, 286. 

coryza, 213. 



INDEX. 297 

Cases of croup, 114-122, 197, 232, 235, 256. 

diphtheria, 123-137, 199, 230, 258-260. 

emphysema, 165. 

faucitis, 109. 
. grinders' asthma, 284. 

haemoptysis, 152-6. 

laryngeal phthisis, 111. 

loss of speech and hearing, 228. 

millstone-makers' phthisis, 283. 

oedema of the glottis, 137-9. 

penetration of charcoal dust into the pulmonary tissue, 282. 

penetration of " English red" into the pulmonary tissue, 288- 
290. 

pharyngitis, chronic, 106. 
granular, 107. 

pharyngo-laryngitis, 108-9. 

phthisis pulmonalis, 156, 158, 159, 162, 163, 193, 203, 209, 211. 

pulmonary gangrene, 164, 238, 239. 

scarlatina anginosa, 168-9. 

stricture of the glottis, 140. 

tuberculosis with pathological proofs of the penetration of 
nebulized fluids into the lungs, 65, 72. 

whooping-cough, 144-7, 216. 
Catarrh of typhus fever, 170. 
Champouillon, experiments of, 43. 
Charriere, apparatus of, 15, 17. 
Chlorine, inhalation of, 201. 
Chloroform, inhalation of, 223. 
Cholera, 170, 194-5. 

Clarke, Dr. Andrew, apparatus of, 28. 
Cohen, apparatus of, 32, 37. 

Comparative merits of apparatus of Sales-Girons and of Berg- 
son, 31. 
Compressed air, inhalation of, 182. 

Tabarie's apparatus for inhalation of, 183. 
Conii extractum, 95. 

Corrigan's apparatus for inhalation of chlorine, &c, 204. 
Coryza, 102, 213. 
Copaiba, oil of, 97. 
Copper, inhalation of vapors of chloride of, 262. 

inhalation of oxide of, 294. 



298 INDEX. 

Creasote vapors, inhalation of, 242. 
Croup, 114, 232, 235, 256. 



Delore, experiments of, 43. 

Demarquay, experiments of, 50. 

his cases of granular pharyngitis, 107. 

Diet, respiratory, 268. 

Digitalis, tincture of, 96. 

Diphtheria, 123, 230, 258. 

Discussion on Poggiale's report to the Imperial Academy of Medi- 
cine, 57. 

Disinfection, 172. 

Diseases to the treatment of which nebulized fluids are appli- 
cable, 99. 

Ditrand-Eardel, his conclusions, 57. 

Emphysema, 165. 
Ether, inhalation of, 223. 
Exanthemata, sore throats of, 167. 

Experiments on men and animals as to the penetration of nebu- 
lized fluids, 39. 

proving the penetration of powders into, the respiratory 
tracts, 277. 

Of Auphaa, 55. 

Battaille, 55. 

Briau, 41. 

Champouillon, 43. 

Delore, 43. 

Demarquay, 50. 

Eieber, 60. 

Fournie, 44, 278. 

Gerhardt, 72. 

Gibb, 73. 

Gratiolet, 54. 

Lewin, 62. 

Mackenzie, 73. 

Moura-Bourouillou, 55. 

Pietra-Santa, 40. 

Key, 43. 

Sales-Girons, 56. 



INDEX. 299 



Experiments of Schnitzler and Stork, 61. 

Semeleder, 73. 

Tavernier, 54. 

Tobold, 61. 

with artificial respiratory apparatus, 45, 56. 

with negative results, 40. 

with positive results, 50. 
Extract of cannabis indicum, 95. 

conium, 95. 

hyoscyamus (alcoholic), 95. 

opium, 95. 

rhatany, 91. 

Fauces, acute inflammation of, 102. 

chronic inflammation of, 104. 
Ferri sesquichloridi, 90. 

subsulphas, 90. 
Fieber, experiments of, 60. 
Fotjrnie, apparatus of, 21. 

conclusions of, 49. 

experiments of, 44, 278. 

work of, 45. 

Gases, inhalation of, 175. 
Gibb, experiments of, 73. 
Glottis, oedema of, 137. 

stricture of, 140. 
Gratiolet, experiments of, 54. 

Haemoptysis, 149. 
Hydrargyri bichloridum, 94. 
Hydrokomion of Bergson, 31. 

of Schneider and Walz, 31. 
Hydrological Academy of Paris, 14. 
Hydrostatic pressure as a nebulizing force, 34. 

Illuminating gas, inhalation of, 218. 
Inhalers for gases, vapors, &c, 177, 214. 
Inhalation employed for systemic medication, 75 

of gases, vapors, &c, 175. 

nebulized fluids, 75. 



300 INDEX. 

Inhalation of nebulized fluids, articles suitable for, 88. 

immediate effects of, 79. 

list of medicines applicable to, 89. 

manner of conducting, 80. 

number, strength, and duration of, 86. 

Siegle's rules for, 85. 
Inhalatorium at Euzet-les-Bains, 13. 
Lamotte-les-Bains, 13. 
Pierrefonds, 14. 
Intermittent fever, 170. 
. Introduction, vii. 
Iodine, inhalation of, 206. 

methods for, 207. 

Berton's method, 211. 

Merrill's method, 214. 

results of in Piorry's thirty-one cases of phthisis, 209. 

Scudamore's formula for, 210. 
Iodinii compositus liquor, 94. 

tinctura, 93. 
Iron, sesquichloride of, 90. 
subsulphate of, 90. 

Lambron, apparatus of, 19. 
Lamotte-les-Bains, inhalatorium at, 13: 
Langenbkck, inhaler of, 179. 
Laryngeal phthisis, 111. 
Laryngitis, acute, 110. 

chronic, 111. 
Laughing gas, inhalation of, 200. 
Lewust, apparatus of, 19, 23, 29, 31, 251. 

experiments of, 62. 

his glass nebulizer, advantages of, 24. 
objections to, 25. 

his objections to Key's conclusions, 44. 

his strictures on FourniS's experiments, 50. 
Lime, inhalation of vapors from, 256. 

water, inhalation of, in croup and diphtheria, 116-123. 
Liquor ferri sesquichloridi, 90. 

potassse arsenitis, 94. 
Lobelia inflata, tincture of, 96. 



INDEX. 301 



Mackenzie, experiments of, 73. 

Mans, his modification of Bergen's apparatus, 30. 

Mathieu (cutler), nebulizer of, 22. 

Matthietj (de la Drome), nebulizer of, 17. 

Medicated atmospheres, 266. 

Mercurial vapors, inhalation of, 260. 

Millstone-makers' phthisis, 283, 292. 

Morphiae acetas, 95. 

Morrhuae oleum, 97. 

Mottra-Bourouillou, experiments of, 55. 

Mudge, inhaler of, 177. 

Narcotic vapors, inhalation of, 253. 
Nebulized sprays as disinfectants, 172. 
Nebulizer of Arnold, 34. 

Author, 32, 37. 

Bergson, 26-7. 

Fournie, 21. 

Lewin, 24, 29. 

Mathieu, 22. 

Bead, 38. 

Sales-Grirons, 15, 16, 17, 19. 

Schnitzler, 21. 

Siegle, 34-5. 

Waldenburg, 19. 
Ne"phogene of Matthieu, 18. 
Niemeyer, observations of, 73. 
Nitrate of potassa, inhalation of fumes of, 249. 

of silver, inhalation of, in chronic affections, 112. 
Nitrous gas, inhalation of, 216. 
Nitrous oxide gas, inhalation of, 200. 

Objections to nebulizer of Lewin, 25. 

Matthieu, 18. 
Oleum cadinum, 97. 

copaibae, 97. 

cubebae, 97. 

morrhuaa, 97. 

olivae, 97. 

pini, 97. 

inhalation of vapors of, 244-5 

26 



302 INDEX. 

Oleum terebinthinse, 96. 
Opii extractum, 95. 

tinctura camphorata, 96. 
simplex, 95. 
Opium, inhalation of vapors of, 253. 
Oxygen, inhalation of, 183. 
Oxy-generator, 192. 

Pathological proofs of the penetration of fluids into the respiratory 
organs, 55, 65-73. 

powders into the lung-tissue, 282. 
Persians, inhalations as practised by the, 263. 
Pharyngitis, acute, 102. 

chronic, 104. 

granulosa, 107. 

sicca, 105. 
Pharyngo-laryngitis, 107, 110. 
Phthisis laryngea, 111. 

pulmonalis, 156, 158, 193, 203, 209, 211, 218, 224, 240. 
Pierrefonds, inhalatorium at, 14. 
Pietra-Santa, Prosper de, experiments of, 40. 

views of, 41. 
Pigmentary matters found in miners' lungs, 291. 
Pine, inhalation of vapors of oils of, 244-5. 
Plumbi acetas, 93. 
Pneumonia, 170. 
Pocket nebulizer of Lewin, 29. 

Poggiale, his report to the Imperial Academy of Medicine, 56. 
Pomeroy, inhaler of, 179. 
Potassae arsenitis liquor, 94. 

carbonas, 93. 

chloras, 92. 

nitras, 249. 

permanganas, 90, 249. 
Potassi bromidum, 92. 

iodidum, 92. 
Proportion of nebulized spray entering the larynx during inhala- 
tion, 76-8. 
Prunus Yirginiana, inhalation of infusion of, 162-3. 
Pulmonary gangrene, 164, 237. 
Pulverizateur portatif of Sales-G-irons, 15, 16. 



INDEX. I 

Pyroligneous acid fumes, inhalation of, 242. 

Quiniae sulphas, 97. 

Head, steam nebulizer of, 38. 
Key Armand, apparatus of, 44. 

experiments of, 44. 
Eeport of Poggiale to the Imperial Academy of Medicine, 56. 
Kesinous vapors, inhalation of, 246. 
Respiratory diet, 268. 

therapeutics, 171. 
Richardson, spray producer of, 31. 

Sal ammoniac, inhalation of vapors of, 250. 
Sales-Gtrons, experiments of, 56. 

his inhalatorium at Pierrefonds, 14. 

his method of treatment, 99. 

his portable nebulizer, 15. 
Scarlatina, 168, 194. 

Schneider and Walz, hydrokomion of, 31. 
Schnitzler, apparatus of, 21. 

cases of, 107. 

and Stork, experiments of, 61. 
Scudamore, inhaler of, 178. 
Semeleder, experiments of, 73. 
Siegle, apparatus of, 33-5. 

use of steam by, 33. 
Small-pox, sore throat of, 169. 
Smoke, inhalation of, 294. 
Snow, inhaler of, 179. 
Sodae chloras, 94. 

liquor chlorinata, 92. 
Sodii chloridum, 92. 
Sore throats of exanthemata, 167. 
Steam as a nebulizing force, 20. 33. 

inhalation of, 264. 
Stramonium, inhalation of vapors of, 254. 

tincture of, 96. 
Sulphur vapors, inhalation of, 217. 
Sulphuric ether, inhalation of, 223. 

comp., inhalation of, 224. 



304 INDEX. 

Summary of views as to the inhalation of nebulized fluids, 173. 
Syphilitic ulcerations, 167. 

Tabarie, apparatus of, for inhalation of compressed air, 183. 

Tannin, 91. 

Tar vapors, inhalation of, 240. 

Ta vernier, experiments of, 54. 

Tincture of belladonna, 96. 

digitalis, 96. 

lobelia inflata, 96. 

opium, 95. 

(camphorated), 96. 

stramonium, 96. 
Tobacco smoke, inhalation of, 256. 
Tobold, experiments of, 61. 
Tonsillitis, 104. 
Tonsils, hypertrophied, 106. 
Trousseau, his demonstration of Demarquay's rabbits, 54. 

his remarks before the Parisian Academy of Medicine, 58. 
Tubes of Bergson, 26. 

as modified by author, 32. 
Mans, 30. 
Winterich and others, 29. 

how made, kept clean, &c, 28-9. 
Turpentine, oil of, 96. 

vapors, inhalation of, 237. 
Typhoid fever, 201. 

Vapors, inhaler for, 177, 251. 

inhalation of, 175. 

proper temperature for inhalation, 177. 
Velpeau, apparatus of, 19. 

Waldenburg, apparatus of, 19. 
Water, cold, 89. 

warm, 89. 

mineral, 98. 

inhalation of hot vapor of, 264. 
medicated vapors of, 265. 
Wedemann, clinical observations of, 73. 
Whooping-cough, 144, 216, 218, 220, 222, 240. 



INDEX. 305 

Wild cherry bark infusion, inhalation of, 162-3. 
Winterich, his modification of Bergson's tubes, 29. 
Wool, inhalation of fumes from, 248. 

Zdekauer, case of detection in lung-tissue of fluid inhaled before 

death, 72. 
Zinci sulphas, 93. 



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Taylor's Movement Cure. 12mo. Illustrated,. 
Virchow's Cellular Pathology. Octavo, . 
Virchow on Morbid Tumors, ..... 

Walker on Intermarriage. 12mo. Illustrated, 
Wythe's Pocket, Dose, and Symptom Book. 32mo., 
Waring's Practical Therapeutics. Eoyal octavo, 
Walton's Operative Ophthalmic Surgery. Octavo. Illus 

trated, 

Watson's Practice of Medicine. Abridged. 12mo. Flexi 

ble cloth, 

Wright on Headaches. 

Zander on the Ophthalmoscope. Eoyal octavo. Illustrated 



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